Withdrawal form

Model Withdrawal Form

If you wish to withdraw from the contract, please fill out this form and send it back to:

I/we (*) hereby withdraw from the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*):

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Ordered on (*) / received on (*): ____________________________

Name of consumer(s): ________________________________

Address of consumer(s): ____________________________

Order number, if applicable: ______________________________

Date: ____________________

Signature of consumer(s), only if notified on paper:

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(*) Delete as appropriate.