Sample revocation form
If you wish to revoke the contract, please fill in this form and send it back to
BLPA|bunk-alliance Rechtsanwaltsgesellschaft mbH
Korngasse 2
67547 Worms
Tel: +49 69 348 771 660
Fax:+49 69 348 771 6666
cancel@blpa.law
– I/we (*) hereby revoke the contract for the provision of the following services (*) concluded by me/us (*)
Consulting package: _____________________________________________________________
___________________________________________________________________________
– Ordered on (*)/received on(*): ____________________________________________________
– Name of the consumer(s): _______________________________________________________
– Address of the consumer(s): ______________________________________________________
– Email of the consumer(s): _______________________________________________________
___________________________
Place, date
__________________________________________________
Signature of the consumer(s)
(*) Delete as applicable