Cancellation Form

Model Withdrawal Form

(If you wish to withdraw from the contract, please complete this form and return it.)

To:

[Name / Company Name]

[Street and House Number]

[Postal Code and City]

Email: [Email Address]

I/we (*) hereby withdraw from the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*):

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

  • Name of consumer(s): __________________

  • Address of consumer(s): __________________

Signature of consumer(s) (only for notification on paper)

Date: __________________

(*) Delete as appropriate.