Model Withdrawal Form 

(If you wish to withdraw from the contract, please complete and return this form.) 

 

To: 

[Your Name / Shop Name] 

[Your Address] 

Email: [your@email.com] 

 

I/we () hereby withdraw from the contract concluded by me/us () for the purchase of the following goods (): 

 

Ordered on () / received on () 

 

Name of customer(s) 

 

Address of customer(s) 

 

Signature of customer(s) (only if submitted on paper) 

 

Date