Revocation form
(Complete and return this form only if you wish to withdraw from the contract)
To:
Simon Systemtechnik GmbH
Ringstrasse 1
89081 Ulm
I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*)
Ordered on (*)/received on (*)
Name of consumer(s)
Address of consumer(s)
Signature of consumer(s) (only if this form is notified on paper)
Date
___________