Model Withdrawal Form

Complete and return this form only if you wish to withdraw from the contract/order.

Name

First Name

Last Name

Address

Please state the delivery address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Order Number

Please state order number below

Ordered On

YYYY

Ordered Received

YYYY

Item number

State Item of the products you wished to return

Withdrawal Statement

I hereby give notice that I withdraw from my order/contract of sale of the following goods (state goods):

Other

Please notify us if there is anything else