Withdrawal form

 

Your first name *

Your last name *

Your telephone no.

If you give your telephone number, we will also gladly call you back.

Your email address *

Hereby give notice that (s) I / we (*) from my / us (*) concluded contract for the purchase of the following products (*) / provision of the following services (*)

appointed on *

Received on *

Name of person / consumer (s) *

Address of person / consumer (s) *

date *

Signature of / consumer (s) (with message on paper)

Send