Cancellation form

According to the art.49, comma 1, lett. h) of the D.Lgs. n. 206/2005 - (fill in and return this form if you want to withdraw from the contract)

Customer references:

Name and Surname: 

Address :

Telephone :


I, the undersigned, hereby: 

Resident in :

Street / Square :

Notifies withdrawal from the contract of sale of the following good(s) / service(s):

ordered on :

received on : 

Date :