Withdrawal Form

If you wish to withdraw from the contract, please complete this form and return it.

To

Weingut Matthias Anton
Obere Hauptstraße 50
D-76863 Herxheim

I/We (*) hereby withdraw from the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*)

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Ordered on (*) ____________ / received on (*) __________________

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Name of consumer(s)

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Address of consumer(s)

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Signature of consumer(s) (only for notification on paper)

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Date

(*) Delete as applicable