LEE ESPOSITO MEDIA COACHING WITHDRAWAL FORM

(If You want to revoke the contract, please fill out this form and send it back.) – An:

Lee Esposito Mediencoaching
Kiefernweg 19, 90513 Zirndorf
coaching@leeesposito.de

• hereby give notice(n) I, we (*) the by me / us (*) concluded contract the purchase of the following products, (*)/ provision of the following service (*)

• Ordered on (*)/received at (*)

• of / Name of consumer(s)

• Address of / consumer(s)

• of / consumer Signature(s) (only message on paper)

• date

(*) delete as applicable.