If you wish to cancel this contract, please complete and submit this form.
I/We (*) hereby give notice that I/We (*) cancel my/our (*) contract of sale of the following goods (*) /for the supply of the following service (*),
Ordered on (*) ____________ / received on (*) __________________
Name of the consumer(s)
Address of the consumer(s)
Signature of consumer(s) (only if this form is notified on paper)
(*) Delete as appropriate