Termination of Agreement

WITHDRAWAL FROM THE DISTANCE CONTRACT TEMPLATE

(the form needs to be filled in and sent back only of you wish to withdraw from the contract)

- Recipient [entrepreneur should enter name, full address and, if available, fax number and email address here]

- I/We(*) hereby inform about my/our(*) withdrawal from the contract of purchasing the following products(*) / contract of delivering following products(*) / contract of commission for following products(*) / contract of providing following services(*):

- Date of signing a contract(*)/reception(*):

- Consumer(-s) name and surname

- Consumer(-s) address

- Consumer(-s) signature(-s) (only if a form is sent in a paper form)

- Date

(*) Cross out the unnecessary.