Withdrawal form

Withdrawal form

"Please complete and return this form only if you wish to withdraw from the contract.

To the attention of [the professional hereby inserts his / her name, geographic address and, where available, his / her fax number and e-mail address]:

I / we (*) hereby notify you (*) that you have withdrawn from the contract for the sale of the property (*) / for the provision of services (*) below:

Ordered on (*) / received on (*):

Product number:

If broken product, provide a picture of the package and the broken part:

Name of Consumer (s):

Address of Consumer (s):

Signature of the consumer (s) (only in the case of notification of this form on paper): ... '

Date:

(*) Delete as appropriate.