Cancellation form


Specimen - revocation form

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

- To Luxtrim GmbH, Magnolienweg 8, 63741 Aschaffenburg-Nilkheim, Fax number: 06021-5848399, Email address: info@akkuteile.de :

- 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.