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

Luca Sales GmbH
Berliner Allee 65
64295 Darmstadt

Fax: +49 (0)6151 3975 111
or by email to: info@myluca.de

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 for paper notification)

- Date

(*) Delete what is not applicable.