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Revocation form

1. To

Marian Swientek
Am Knorrspfad 25
41812 Erkelenz
Telefon: 02465980415
E-Mail: info@schnecken-elektrozaun.de

(Name, address, telephone number and email address of the contractor)
 
 
2. Hereby I / we revoke the concluded contract to me / us about a
purchase of the following goods / obtaining of following service:
 
..............................................................................
 
..............................................................................
(Name of the product, if necessary, order number and price)
 
3. Ordered at:                 4. Received at:
 
.............................             .............................
(Date)                 (Date)
 
 
5. (Name, address of the consumer)
 
.............................
 
.............................
 
.............................
 
 
............................
7. Date
 
 
....................................................
Customer signature
(only with written revocation)

 

 

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