Sample Revocation Form

For exercising the right of revocation, you can use this form or you can formulate your own declaration of revocation. You will need the Adobe Acrobat Reader (available free of charge) for displaying and printing the information regarding returns.

An:
EMP Retourenservice
Am Stadtwalde 12
48432 Rheine
Germany

Fax: +49 591-914320
E-Mail: mailbox@emp.de

or to any other EMP company

I/we (*) hereby revoke the agreement which I/we (*) entered into for the purchase of the following goods (*)/provision of the following service (*):

Order number (*)

Ordered on (*) / received on (*)

Name of consumer(s)

Address of consumer(s)

Signature of consumer(s) (only on notification in paper form)

Date

(*) Please delete as appropriate