Model withdrawal form

(Complete and return this form only if you wish to withdraw from the contract)

 
 
I hereby give notice that I withdraw from my contract of sale of the following goods:
 
 
 
 
 
 
 
 

Ordered on / received on:
 
 
 

Name of consumer:
 
 
 

Address of consumer:
 
 
 

Signature of consumer: (only if this form is notified on paper)
 
 
 

Date: