Model withdrawal form

(If you want to withdraw from the contract, please fill out this form and send it back.)

To [here the name, address and, if appropriate, the facsimile number and e-mail address of the entrepreneur is to be inserted by the contractor]:

Hereby give notice (s) I / We (*) withdraw from my / our (*) contract entered into for the purchase of the following Goods (*) / provision of the following service (*)

Ordered on (*) / received on (*) Name / consumer (s) Address of / consumer (s) Signature / consumer (s) (only for message on paper) date (*) Delete where inapplicable.