Revocation Form
Should you revoke from this contract, then please fill in this form and send it back to us,
to the following address:
Momantai Consulting UG
Soul Objects
Prenzlauer Allee 24
10405 Berlin
Germany
or
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:
..............................................................................
..............................................................................
(Name of product, if applicable order number & price)
Product purchased on:
.............................
Date
Product received on:
.............................
Date
Name and address of consumer
.............................
.............................
.............................
.............................
Date
....................................................
Customer signature
(only in case of revocation in writing)
