(If you wish to revoke the contract, please fill in this form and return it to us).
3409 Executive Center Drive
– I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of
the following articles / Services:
– Ordered on (*)/received on (*):
– Name of the consumer(s):
– Address of the consumer(s):
Date Signature of the consumer(s) (only on printed form)
(*) Please delete where applicable.