Revocation form

Sample revocation form

If you wish to revoke the contract, then please fill in this form and return it to us.

To

LIVOS Pflanzenchemie Forschungs- und Entwicklungs GmbH & Co. KG

Auengrund 10

29559 Wrestedt

Germany

E-mail: info@livos.de

Telephone: +49 5825 / 880

Fax: +49 5825 / 8864

I/we hereby revoke the contract I/we concluded to purchase the following goods/receive the following service:

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(Name of the goods, if applicable, order number and price)

Goods ordered on:

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Date

Goods received on:

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Date

Name and address of consumer
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.............................
.............................
.............................
Date

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Signature of customer (only in the case of written revocation)

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