Sample revocation form

Sample revocation form

(If you wish to revoke the Agreement, please complete this form and send it back.)

To

Zippo GmbH
Retoure zippo.de
Groendahlscher Weg 87
46446 Emmerich am Rhein
Germany

Facsimile +49 (0) 2822 600 650

E-mail shop@zippo.de

I/we (*) hereby revoke the Agreement concluded by me/us (*)regarding the purchase of the following

Goods (*)/the performance of the following service (*)

Ordered on (*)/received on (*)

Name of the consumer(s)

Address of the consumer(s)

Signature of the consumer(s) (only if notice is issued on paper)

Date

(*) delete as appropriate