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Declaration of revocation
If you want to withdraw your contract, please fill out this form and send it back to:
An die meconet e.K.,
Seelbacher Weg 7,
57072 Siegen,
Fax 0271/703087 99,
Hereby i withdraw our enclosed contract over the purchase of the following goods (*)/ provision of the following services (*):
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Date ordered (*)/date delivered (*)
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Consumer's name
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Consumer's address
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___________________________________________________________________
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Consumer's signature (required in a written communication only)
Date
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(*) Delete as applicable.
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