B.Withdrawal form template

(you should only complete and send this form if you would like to withdraw from the contract)

  • For the attention of (insert the business owner’s name, fulladdress and, if possible, fax number and email address)
  • I/We (*) hereby declare that I/we (*) wish to withdraw fromthe contract of sale for the following item/service (*)
  • Ordered on/received on (*)
  • Name of the consumer(s) and user(s)
  • Address of the consumer(s) and user(s)
  • Signature of the consumer(s) and user(s) (only if thisform is submitted on paper)
  • Date