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:
..............................................................................
..............................................................................
(Name of the goods, if applicable, order number and price)
Goods ordered on:
.............................
Date
Goods received on:
.............................
Date
Name and address of consumer
.............................
.............................
.............................
.............................
Date
....................................................
Signature of customer (only in the case of written revocation)