(If you wish to withdraw from the contract, please fill in this form and return it.)

To: KUPF Services GmbH, Untere Donaulände 10/1, 4020 Linz, Austria, [email protected] – for forwarding to the issuing organiser – or directly to the organiser (contact details in the shop or on the voucher):

I/We (*) hereby declare that I/we (*) withdraw from my/our (*) contract for the purchase of the following voucher:

Ordered on (*) / received on (*): ____________

Name of consumer(s): ____________

Address of consumer(s): ____________

Signature (only if this form is notified on paper): ____________

Date: ____________

(*) Delete as appropriate.