Revocation instruction form

To
Escora Luxus Premium Dessous
Diamor Trading GmbH
Aderstraße 33
4850 Timelkam

by Fax to: +43 7672 95251 - 77
or via E-Mail to: infonospamplease@nospampleaseescora.de

Hereby I / we 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 customer(s)

Address of customer(s)

Signature of customer(s) (only in the case of a communication on paper)

Date

^* Please cross off what is not applicable.