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Revocation Form

If you want to revoke your contract, please fill out the following form and click "Send".
As confirmation we will send you a copy of the form by email.

I revoke the contract closed by me about the purchase of the following items:
Order Number:  
Date ordered: * (i.e. 13.06.2014)
Date received: (if you already received the goods, i.e. 13.06.2014)
Name: *  
Street / No: *  
Postal Code: *  
City: *  
Country: *  
Email: *  
  *I agree, that the data from this form will be collected and processed in order to answer my inquiry .
You can find more information in our Privacy policy.
Please enter the code shown in the picture.

Security code:


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