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Revocation form

Specimen - revocation form

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

To :
ADCS - Alcohol  Drug Checking Systems e.K.
Jörg Mielenz 
Benstaben 5
D-23858 Barnitz
E-Mail info@adcs-germany.com

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)

_____________________________________________________

Address of the consumer(s)


_____________________________________________________

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

__________________

Date

__________________

(*) Cross out the incorrect option.

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