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Revocation form

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

To

DICTUM GmbH
Gottlieb-Daimler-Str. 3
94447 Plattling, Germany


Phone: +49 (0)9931 4058-902
Fax: +49 (0)9931 4058-800
E-Mail: info@dictum.com

 

 

I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods / provision of the following service:

................................................................................................

................................................................................................

................................................................................................
(Name & Article number, Ordering number and Price)

 

Ordered on:  ............................. (Date)                                           

Received on: ............................. (Date)

 

Name and Address of consumer(s)

...............................................................

...............................................................

...............................................................

 

Date: ...................................                              

Signature of consumer(s): ..................................................
(only with message on papers)


Revocation form as PDF for Download

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