REVOCATION FORM
 Specimen - revocation form
 
	(If you wish to revoke the contract, please fill up this form and send it back to us.)
 
	- To DMS Sporting GmbH & Co. KG, Dr.-Walter-Bruch-Strasse 9, 66606 St. Wendel, Fax number: 06851 97 87 99, Email address: info@powermint.de :
 
	- I/we (*) herewith revoke the contract concluded by me/ us (*) regarding the purchase of the following  products (*)/
	  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 in case of a notification on paper)
	- Date
 
	(*) Cross out the incorrect option.