(If you wish to revoke the contract, please fill up this form and send it back to us.)
- To Julia Roth, Drosteweg 17, 50354 Hürth, Email address: email@example.com
- I/we (*) herewith revoke the contract concluded by me/us (*) regarding the purchase of the following products (*)/the provision of the following service (*)
- Ordered on (*)/ received on (*)
- Name of the consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only in case of a notification on paper)
(*) Cross out the incorrect option.