Model Cancellation Form

To [here enter the trader’s name, geographical address and, where available, fax number and e-mail address are to be inserted by the trader]:

I/We hereby give notice that I/we cancel my/our contract of sale of the following products [enter details of goods and any reference].

Ordered on [date]/received on [date],

Name: [enter name or names in which the order was made],

Address: [enter your address],

Signature: (only if this form is notified on paper)Date: [date]

enter details of goods and any reference