Specimen - revocation form

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

- To Kellermann GmbH, Jülicher Straße 338, 52070 Aachen, Fax number: 0241 9380816, Email address: bestellung@kellermann-online.com :

- 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.

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