Withdrawal Form

Draft for review. Replace every [PLACEHOLDER] and have a lawyer check this page before you publish it.

Model withdrawal form (Directive 2011/83/EU, Annex I(B)). Complete and return this form only if you wish to withdraw from the contract.

To [COMPANY NAME], [REGISTERED ADDRESS], [EMAIL]:

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),
Ordered on (*)/received on (*),
Name of consumer(s),
Address of consumer(s),
Signature of consumer(s) (only if this form is notified on paper),
Date

(*) Delete as appropriate.