Revocation form

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

To
GMU Textil Vertriebs GmbH
Konrad-Zuse-Ring 11

61137 Schöneck, Deutschland

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),
_______________________________________________
_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________
Address of consumer(s)
_________________________________
_________________________________
_________________________________

Date:________________

Signature of consumer(s) :___________________________________________
(only if this form is notified on paper)

(*) Delete as appropriate