To:
Ellenity GmbH
Albisblick 51
6319 Allenwinden
Schweiz
I/we (*) hereby revoke the contract concluded by me/us (*) regarding the purchase of the following goods
Order Number: _____________________
Product/s: __________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Ordered on (*) ____________ / received on (*) _________________
________________________________________________________
Name of the customer
_______________________________________________________ Address of the customer
________________________________________________________
Signature of the customer (only in case of paper communication) _________________________
Date, Place
(*) Please cross out where not applicable