Withdrawal

Complete and return this form only if you wish to withdraw from the contract.

To

Longford Town House
Benedikt Eikelmann
Oststraße 3
48231 Warendorf
Germany

Fax: 02581 - 9891923
E-Mail: info@eirisch.com

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
   
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy
 

* required