Model withdrawal form (complete and return this form only if you wish to withdraw from the contract)

 To [here the trader’s name, geographical address and, where available, his fax number and e-mail address are to be inserted by the trader]

 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

(*) Unnecessary deletion