Revocable Form
Model withdrawal form
(If you want to revoke the contract, please fill out this form and send it back)
On
Becopa
Bruno-Bürgel-Weg 18
12439 Berlin
Fax: 030 – 315 675 98
Email: info@becopa.de
I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of the following goods (*) / the provision of the following service (*)
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Ordered on (*) / received on (*)
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Name of the consumer (s)
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Address of the consumer (s)
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Signature of the consumer (s) (only when notified on paper)
Date………………………………………………………………………………………………………….
(*) Delete as appropriate
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