Right of revocation & revocation form

Revocation form

(Complete and return this form only if you wish to withdraw from the contract.)

To
MacBRITE Chemische Fabrikations GmbH
Passauerstrasse 65A
94060 Pocking
Fax: +49 8531 317 276
E-Mail: mail[at]macbrite.de

I/We* hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*) / provision of the following service (*)
_______________________________________________
_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of the consumer(s) ______________________________________
Address of the consumer(s)
_________________________________
_________________________________
_________________________________

_________      _____________________________________________________
Date                signature of the consumer(s) (only with message on paper)

_____________________________________________________________________________________
(*) delete as applicable