(Copy and paste this form into a word/email, fill in the necessary details and send it back only if you wish to withdraw from the contract. The form should be printed, signed and sent scanned to the email address below, or included in the parcel with the returned goods. A copy of the invoice can also be used.)

 

I hereby give notice that I withdraw from the contract for the purchase of these goods (*)/the provision of these services (*):

• Date ordered (*)/date received (*)
  Order number:
  Funds for ordering, or for delivery, have been sent by (*)
  and will be refunded in the following way (in case of transfer to an account, please send the account number) (*)
  Consumer's name:
  Consumer's address:
  Email:
  Phone:

 

 

In (fill in the place here), On (fill in the date here)

 

                                      (signature)
______________________________________

             Customers name and surname

 

(*) Delete where not applicable or add details.