Withdrawal form

Appendix I: Standard form for withdrawal

Standard Form for Withdrawal

(Complete this form and return it only when you want to revoke the agreement)

– To: [Entrepreneur’s name]
[Entrepreneur’s geographic address]
[Entrepreneur’s fax number, if available]
[Entrepreneur’s email address or electronic address]

– I/We hereby inform you that I/we wish to revoke our agreement on the sale of the following products: [specification of the product]*
the delivery of the following digital content [specification of the digital content]*
the performance of the following service [specification of the service]*

– Ordered on*/received on* [date of ordering the services or receiving products]*
– [Consumer’s name]
– [Consumer’s address]
– [Consumer’s signature] (only when this form is submitted on paper)

*) Delete and/or complete where appropriate.