Hereby, I/we revoke the contract concluded by me/us for the purchase of the following goods:

Ordered on:

Ordered by (Name of the purchaser):

Order No:

Reason for the revocation:
☐ Size was too small
☐ Size was too large
☐ Changed my mind
☐ Item was not as described
☐ Received the wrong item
☐ Damaged or defective
☐ Desired a different color/Don’t like the color
☐ Sample Order
☐ Other reason:

Date                                                      Signature