Model cancellation form

Complete and send this form only if you wish to cancel an eligible distance contract.

To: Sukhvendra Singh, J6XR+2X8, Etawah 206120, India — sukhvendrasingh66@gmail.com

I hereby give notice that I cancel my contract of sale for the following goods:

____________________________________________

Order number: ______________________________

Ordered on / received on: ___________________

Customer name: _____________________________

Customer address: ___________________________

Signature (only if sent on paper): ____________

Date: _____________________________________