Model withdrawal form

Only complete and return this form if you wish to withdraw from the contract.

To: Etiartini (Internet Lifestyle) [ADDRESS], Goes, Netherlands [[email protected]]

I/We* hereby inform you that I/we* withdraw from our contract of sale of the following products:

• Product(s): ______________________
• Ordered on* / received on*: ______________________
• Order number: ______________________
• Name of consumer(s): ______________________
• Address of consumer(s): ______________________
• IBAN (for refund, if different from the payment method): ______________________
• Signature (only for paper form): ______________________
• Date: ______________________

* Delete as applicable.

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