Formulaire d'annulation

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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