MODEL WITHDRAWAL FORM

Complete and return this form only if you wish to withdraw from a contract.
You may use another clear statement instead.

To: [Seller legal name — to be completed before sales open]
Address: [Seller address — to be completed before sales open]
Email: [Seller email — to be completed before sales open]

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*) / for the provision of the following service (*):

Ordered on (*) / received on (*):
Name of consumer(s):
Address of consumer(s):
Signature of consumer(s) (only if this form is notified on paper):
Date:

(*) Delete as appropriate.