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