Sample of the withdrawal form

Withdrawal from the contract form

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Withdrawal from the contract notice

- Recipient: Belet a.s., Dělnická 1253/37, 431 91  Vejprty


- I/We (*) wish to inform you that I/We (*) hereby withdraw from the contract for the following goods (*):


- Order date (*)/Date of delivery (*):


- Document number (order/delivery note/invoice (*)):


- First name and surname:


- Customer Address:


- Customer signature (only if you send this form by post):


- Date: