Annex 1. MODEL WITHDRAWAL FORM

(Complete and return this form only if you wish to withdraw from the contract)

 

To NV PLASTIGI

Lenskensdijk 3

2200 HERENTALS

België

BE 0406.043.681

info@valiente.be

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 I/We (*) hereby give notice that I/we (*) withdraw from our contract of sale for the following goods (*) for the provision of the following service (*)  

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 Ordered on (*)/Received on (*)

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 Name /Names of consumer(s)

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Address of consumer(s)

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Date

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ignature of consumer(s)  

(only if this form is notified on paper) 

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(*) Delete as appropriate