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To
FLEURS DE PARIS
Fleurs de Paris Deutschland GmbH
Egellsstraße 21
13507 Berlin
Via fax to: +49 30-120843599
Or via email to info@fleursdeparis.fr
Hereby I/we* withdraw the contract for the purchase of the following goods made be me/us.*
Ordered on */ received on*
Name
Address
Signature(only for information on paper)
Date
* delete as appropriate