§7 cancellation form Model withdrawal form (If you want to cancel the contract, please fill out this form and send it back, together with the goods you want to return.) On : LACCICO Zabenstedter Str 29 06347 Gerbstedt Germany E-Mail info@laccico.com I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of the following goods (*) / the provision of the following service (*) _____________________________________________________ Ordered on (*) / received on (*) __________________ Name of the consumer (s) _____________________________________________________ Address of the consumer (s) _____________________________________________________ Signature of the consumer (s) (only when notified on paper) __________________ date