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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

___________

 

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