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)