Specimen - revocation form
(If you wish to revoke the contract, please fill up this form and send it back to us.)
- To Eckstein GmbH, Am Ostbahnhof 3, 38678 Clausthal-Zellerfeld, Email address: [email protected] :
- I/we (*) herewith revoke the contract concluded by me/ us (*) regarding the purchase of the following  products (*)/
  the provision of the following service (*)
- Ordered on (*)/ received on (*)
- Name of the consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only in case of a notification on paper)
- Date
(*) Cross out the incorrect option.

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