Online withdrawal form

Complete and send this form if you wish to withdraw from the contract. The date of sending the from applies as date of the withrawal declaration. We will confirm the receipt of your withdrawal by email. With pushing "Send" you confirm that you have read the privacy notice.



SR Sales UG (haftungsbeschränkt)
Leubinger Straße 19
99610 Sömmerda


I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods:
Order number:
Order date:
Customer (Company name, first name, last name):
Street / No.:
Postcode/ZIP, City:
Email (for confirming the receive of withdrawal):
The fields marked in bold are the mandatory fields!