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 Returns
Synergy Retail Support Ltd
Ravens Way, Crow Lane Industrial Estate
Northhampton NN3 9UD
UK

Email: mailbox@emp.co.uk

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