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(If you want to revoke the contract, please fill out this form and send it back.)



mme Mannheim Medizinelektronik UG (limited liability)

Eichelbergstr. 38

D-68163 Mannheim

Phone: +49 176 84318733



I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*)


Bestellt am (*)                    _cc781905-5cde-3194 -bb3b-136bad5cf58d_           _cc781905 Received on (*)


Name of consumer(s) 

Address of consumer(s)




Signature of consumer(s):

(only if notification is on paper)



(*) Delete where not applicable

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