Cancellation form


Cancellation Form I hereby revoke (*) the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*) _______________________________________________________ _______________________________________________________ Order on (*) ____________ / received on (*) _________________________ ________________________________________________________ Name of consumer(s) ________________________________________________________ Address of the consumer(s) ________________________________________________________ Signature of the consumer(s) (only in the case of communication on paper) _________________________ Date (*) Delete as appropriate