If you wish to cancel the contract, please fill out this form and send it back.

To
Company: Quentin Terpentino Genetics, owner Lukas Heinrich
Address: Lange Straße 26a, 29342 Wienhausen
Email: info@qtgenetics.com
Tel.: 0179 738 68 12

Hereby, I/we (*) revoke the contract I/we (*) concluded for the purchase of the following goods (*):

Ordered on (*)/Received on (*):

Name of the consumer(s):

Address of the consumer(s):

Signature of the consumer(s) (only if communicated on paper):

Date
(*) Delete as appropriate.