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Hiermit widerrufe(n) ich/wir (\*) den von mir/uns (\*) abgeschlossenen Vertrag über den Kauf der folgenden Waren (\*)/die Erbringung der folgenden Dienstleistung (\*):
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Unterschrift des/der Verbraucher(s) (nur bei Mitteilung auf Papier):
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Datum:
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