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(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)
Date
(*) Deletewhere not applicable