Form for Withdrawal

Please copy the form in Microsoft Word or into an email and send it back only if you wish to withdraw
from the contract or agreement
 

Notice of withdrawal

Recipient:                 

 

                               

                 

 

I want to inform you (*) that I hereby withdraw (*) from the contract for the purchase of the following goods/services:

 

 

Date of order (*) / date of receipt (*):

First name and surname of the customer:

Address of customer:

Signature of customer (only if this form is sent in paper form)

 

Date:

(*) Delete if unappropriate or complete the data.