Purchase withdrawal form
(fill in this form and send it electronically or by mail to the Supplier only if you wish to withdraw from the purchase)

Notice of withdrawal
Supplier’s name and address

I/We announce (*) that I am/We are withdrawing (*) from the purchase agreement of this product or service:

Ordering date (*) / date of receipt (*)

User name and surname

User address

User signature (only if this form is sent in paper form)

Date

(*) Delete where not applicable.