Revocation form
(Complete and return this form only if you wish to withdraw from the contract.)
To
Max Mustermann / Muster GmbH
Musterstraße 11
66666 Musterstadt
Fax: 000-777777
E-Mail:info@muster.de
[enter the name, address and if appropriate, fax number and e-mail-address of the entrepreneur by the entrepreneur]:
I/We* hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*) / provision of the following service (*)
_______________________________________________
_______________________________________________
Ordered on ___________________ (*)/received on _______________________(*)
Name of the consumer(s) ______________________________________
Address of the consumer(s)
_________________________________
_________________________________
_________________________________
_________ _____________________________________________________
Date signature of the consumer(s) (only with message on paper)
_____________________________________________________________________________________
(*) delete as applicable