If you want to cancel the contract, please fill out this form and send it back.
To: ROOR - Pure Smoke Culture
Name of the company: Vorsicht Glas GmbH
Street and house number: Paul-Klee-Straße 3
Postcode & City: 67227 Frankenthal
Fax: +49 (0) 6233 6070262
I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*):
Ordered on (*)/received on (*):
Name of the consumer(s):
Address of the consumer(s):
Signature of the consumer(s) (only in the case of communication on paper):
* please delete as applicable
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