Revocation form

Revocation form

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

To
Alla Senkina
Berliner Allee 142
13088 Berlin
Fax: (030) 20058855
E-Mail:info@allagalerie.com

[enter the name, address and if appropriate, fax number and e-mail-address of the entrepreneur by the entrepreneur]:

I/We* hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*) / provision of the following service (*)
_______________________________________________
_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of the consumer(s) ______________________________________
Address of the consumer(s)
_________________________________
_________________________________
_________________________________

_________      _____________________________________________________
Date                signature of the consumer(s) (only with message on paper)

_____________________________________________________________________________________
(*) delete as applicable