Droit de rétractation et formulaire de retrait

Revocation form

(Complete and return this form only if you wish to withdraw from the contract.)

To

elasto form KG
Franz-Sollfrank-Str. 6
92237 Sulzbach-Rosenberg

Germany

Fax: +49 (0) 96 61 / 8 90-500
E-Mail:service2@elasto.de



[enter the name, address and if appropriate, fax number and e-mail-address of the entrepreneur by the entrepreneur]:

I/We* hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*) / 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) (only with message on paper)

_____________________________________________________________________________________
(*) delete as applicable