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 (*) _________________________
 
 
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Name of consumer(s)

 

 


________________________________________________________
Address of the consumer(s)

 


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Signature of the consumer(s) (only in the case of communication on paper)


_________________________
Date
(*) Delete as appropriate