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Withdrawal Form

If you want to withdraw from the treaty, please fill this form and send it back.

  • Should lack some informations, so is it really possible, that there is none possibility to contact you in the case of further inquiries. This form comes to us over a so named form mailer which works under unsing of CGI. Because of this it is not possible to find in the incoming e-mail something others than the informations you gave, even not your e-mail adress! The in the form given informations have to be completely without fail!
  • We especially point out to the fact, that the from you here given informations become handled absolutely confidential, and become used solely for the here described making of contact. Your data become never selled by www.painanta.com to third persons or organizations and become not stored in a special or external way.

To:

 

 

 

 





With this, I withdraw from the treaty about buying of the following goods
or make of the following service:

Please fill in here:
Attention, no URL (eg. http://www...)
(maybe Invoice Number:
ordered on (date):
Adress of the Client
sal.:
your Company:
First name / Family Name:
further:
Street Name and House Number:
ZIP-Code / Location:
Country:
Telephone Number:
eMail:

____________________________
Subscription of the Client
(only if you use paper)
Date:

verification code for the send: new code

Please fill in the displayed signs.

Ignore capitalization.


This is an Withdrawal Form. You can print this form, after it is completely filled,
(2 pages A4) and send it per Letter (Do not forget the Subscripition!), or you click here
on "send", and the Form comes to us per E-Mail.

(Formular-Service vom Formular-Chef)