Model withdrawal form

(If you want to cancel the contract, please complete this form and send it back.)

- To Saeed-Shop, Hofhausstraße 25, D-61130 Nidderau, Germany,

- I hereby revoke my concluded contract over the purchase of the following
  goods / provision of the following services (*)

- Ordered on / received on (*)

- Name of the consumer

- Address of consumer

- Signature of the consumer (for message on paper)

- Date

(*) Delete where not applicable.