Withdrawal form

Pursuant to Art. 49, paragraph 1, letter h) of Legislative Decree no. 206/2005 - (fill in and return this form if you wish to withdraw from the contract)

Customer details:

First name and last name:

Address :

Telephone :

E-mail:

The undersigned hereby:

Resident in :

Street / Square :

notifies the withdrawal from the sales contract for the following good(s)/service(s):

ordered on :

received on :

Date :