Revocation form



To: AG
Kappeneck, 20 c
86152 Augsburg

via E-Mail :

(If you wish to revoke the contract, please fill up this form and send it back to us.)


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) 


Adress of the consumer (s)


Signature of the consumer(s) (only in case of a notification on paper)




(*) Cross out the incorrect option.

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