Sample revocation form
If you wish to revoke this contract, please fill in this form and send it to:
Simpert Reiter GmbH
Weddigenstraße 2-6
86179 Augsburg
GERMANY
Mail: info@simpert-reiter.de
Fax: (+49) 821 24075-10
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 customer _____________________________________________
Address of the customer _____________________________________________
____________________________
Place, date
____________________________
Signature
(*) Please delete if not applicable
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+49 (0)821 - 240 75 0
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Friday: from 8:00 a.m. to 1:00 p.m.
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