Revocation Form

 SUMAGEZA - Revocation Form

 

 

 

If you wish to revoke the contract, please complete this form and send it to us at:

SUMAGEZA – Soumaya Zairi                    Fax: +49 (0) 5473 8019853

Untere Knollstraße 17                                   email: soumaya.zairi@sumageza.com

49179 Ostercappeln Germany

 

- I/we hereby revoke (*) the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*)

 

 

- Ordered on (*) / received on (*):_ _                                                                      

- Name of the consumer(s):_______                                                                      

- Address of the consumer(s):                                                                                           

 

 

                                  

Date                                                               Signature of the consumer(s):

(*): Delete where inapplicable

  

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