Withdrawal

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

To

Alexander Albrant
Alexander Albrant
Neuer Hagen 24
21436 Marschacht
Germany

E-Mail: moin@mirumir.de

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