Revocation Form

To
dephyte e.K.
Ahornweg 6
33449 Langenberg
Germany

by fax to: +49 (0) 5248 202 98 - 31
or by email to: info@dephyte.com


I/ We* revoke the concluded me/ us contract for the purchase of the following products/ the provision of the following service*.

Order Number
_____________________

Name of the consumer
_____________________

Address of the consumer
_____________________
_____________________
_____________________

Signature of the consumer (only required for communication on paper)
_____________________

Date
_____________________

* Please remove if not applicable.