Withdrawal Form

Withdrawal Form
Complete and return this form only if you wish to withdraw from contract.
[here the trader’s name, address and, where available, fax number and e-mail address are to be inserted by the trader]:
I/We* hereby give notice that I/we* withdraw from my/our * contract of sale of the following goods for the provision of the following service.
Ordered on/ received on(*):          
Order Number:          
Name of consumer(s):          
Address of consumer(s):          
Signature of consumer(s):          
(only if this form is notified on paper)
* Delete as appropriate