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If you wish to cancel the contract, please complete and return this form.
Laedi Ortho AG, Amlehnstrasse 22, 6010 Kriens, Switzerland
2) Your details
I /We (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*):
a) ordered on (*) / received on (*)
b) Customer name
c) Customer address
d) Signature (only for communication on paper)
e) Place and date
(*) Please delete where inapplicable.