Sample revocation

Sample withdrawal form

(If you want to revoke the contract, please fill out this form and send it back.)

PROOX Ltd

Seglerweg 1

6972 Fussach

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 at (*) ____________________________________

Invoice number, if available: ____________________

Invoice amount: ___________________________________

Name of consumer(s) ___________________________________________

Address of consumer(s) __________________________________________

__________________________________________

Date ____________________

Signature of consumer(s) (only if notification is on paper)

__________________________

(*) Delete where not applicable.