Sample revocation form(If you want to cancel the contract, please fill in this form and send it back.) An Cologne Energy | Mr. Oliver Rothweiler, Neusser Strasse 422C, 50733 Cologne, team@cologne-led.de, Fax: 0221-9924574 I/we (*) hereby revoke the contract for the purchase of the following goods (*)/performance of the following service (*) concluded by me/us (*) Ordered on (*)/received on (*) Name of the consumer (s) Address of the consumer (s) Signature of the consumer (s) (only for communication on paper) Date - Date (*) Delete as applicable. |