Adsamm Werbe- und Marketing GmbH
by fax to: +43 316 680 297
or by email to: email@example.com
I/ We* revoke the concluded me/ us contract for the purchase of the following products/ the provision of the following service*.
Order date*/ received date*
Name of the consumer
Address of the consumer
Signature of the consumer (only required for communication on paper)
* Please remove if not applicable.