Withdrawal

Complete and return this form only if you wish to withdraw from the contract.

To

Boli Pura GmbH
Tobias Heilmann-Schuricht
Südliche Hauptstraße 5
83700 Rottach-Egern
Germany

Fax: +49 8029 3450009
E-Mail: kontakt@bolipura.de

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
   
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy
 

* required