Sample revocation form

If you want to cancel the contract, please fill out this form and send it back.

To: ROOR - Pure Smoke Culture

Name of the company: Vorsicht Glas GmbH

Street and house number: Hammstraße 17

Postcode & City: 67227 Frankenthal

Fax: +49 (0) 6233 6070262


I/we (*) hereby 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 the consumer(s):

Address of the consumer(s):

Signature of the consumer(s) (only in the case of communication on paper):


* please delete as applicable