Withdrawal Form

Model Withdrawal Form

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

To:
[Your Company Name]
[Street Address]
[Postal Code, City]
[Country]
Email: [your@email.com]

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 (*) ____________

Name of consumer(s): ____________

Address of consumer(s): ____________

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

Date: ____________

(*) Delete as appropriate.