Specimen - revocation form

(If you wish to revoke the contract, please fill up this form and send it back to us.)

- To Kai Mißfeld, Tegelbarg 41, 24576 Bad Bramstedt, e-mail address: info@der-getriebedoktor.de:

- 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)
- Date

(*) Cross out the incorrect option.