Withdrawal Form

Model Cancellation Form

- I / we [*] hereby give notice that I / we [*] cancel my / our [*] contract of sale of the following goods [*] / for the supply 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