Revocationform

Specimen - revocation form

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

- To E-CLIPS UG Geschäftsführer Thomas Frank Prof.-Ferd-A-Kehrer-Str.21 D-67583 Guntersblum Tel.:0152 02938685 E-Mail: info@bossmobil.net :

- 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.