(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.