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Specimen - revocation form

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

- To Damnitz & Franz GbR, Horster Str. 72, 45897 Gelsenkirchen, Email address:

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)

Please enter the word displayed in the image correctly. Captchar Image

 The fields marked in bold are the mandatory fields!
(*) Cross out the incorrect option.