Withdrawal form model
For the attention of _______________________________________________________________
(Here you must insert the name of the employer, his full address and, if he has them, his fax number and his email address):
I hereby communicate / communicate (*) that I withdraw from me / we withdraw from our (*) sale contract of the following good / provision of the following service (*)
- Name of the good / service (*): ______________________________________________
- Ordered on (*): __ / __ / ____
- Received on (*): __ / __ / ____
- Name: ______________________________________________________________
(name of the consumer and user or consumers and users).
- Address: _____________________________________________________________
(address of the consumer and user or consumers and users).
Signature of the consumer and user or consumers and users:
(only if this form is submitted on paper).
Date: __ / __ / ____