(If you want to cancel the contract, please fill out this form and send it back.)
– To La Casa del Habano / Casa del Puro e.K., Hauptmarkt 9, 90403 Nürnberg, firstname.lastname@example.org
– 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 when notified on paper)
(*) Delete if inapplicable.