Template cancellation form

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

Picanova GmbH
Hohenzollernring 25
50672 Cologne
Telephone: +49 (0)180 5 588753* - (Mo.-Fr. 10-15 o'clock)
Fax: +49 (0)180 5 226829*

(*£ 0.20/min from landlines. Higher fees may be applicable for calls from mobile phones.
Cost per minute correspond to the tariff of your network provider for a regular international call, max. *£ 0.50/min)
E-Mail: info@picanova.co.uk

I/we hereby cancel the contract that I/we entered into for the purchase or the following goods and/or the provision of the following service:


Order date:
Date of receipt:

Name: _______
Address:
Signature:
(only required for hard copy notifications)

Date _______________

Cancel
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