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If you wish to revoke the contract, you may complete this form and send it to:


Adress for Returns


Jan Matthiesen

Emil-Nolde-Strasse 19

51375 Leverkusen





I/we* hereby revoke the contract concluded with me/us* regarding the purchase of the following goods*: __________________________________________________________

the provision of the following services* _____________________________________

Ordered on/received on* ______________

Name(s) of the consumer(s) ________________________________________________

Address(es) of the consumer(s) ______________________________________________

Signature(s) of the consumer(s) _____________________ (only if notification given on paper)



(*) Please delete as appropriate.


Return charges in case the right of revocation is exercised


Costs of the return are accepted by the buyer.

Returns from abroad are borne by the buyer.

Please use the return slip in any case.

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