(this form should be filled in and sent back only if you would like to withdraw from the contract)

Addressee [here the trader should write the name of the trader, full address, and if it is available, fax number and e-mail address]

 I/We(*) hereby inform that I/We(*) withdraw from the following sales contract:

Date of the contract

Name and surname of the consumer

Address of the consumer

Signature of the consumer (only if the form is sent in paper form)


(*) Deletewhere not applicable


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