revocable form

(If you want to cancel the contract, please fill out this form and return it.)

to

Peters GmbH
Hansastraße 11
59557 Lippstadt
onlineshop@peters-pralinen.de

I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of the following goods (*) / 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 when notified on paper)

____________________________________________________
date

(*) Delete as appropriate.