Cancellation form

Specimen - revocation form

(If you wish to revoke the contract, please fill up this form and send it back to us.)

- To aricona GmbH, Im Eck 5, 79199 Kirchzarten, Fax number: 07661 62985 10, Email address: info@aricona.com :

- 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.