Model Withdrawal Form

(this form should be filled in and returned only if you wish to withdraw from the contract)

Addressee (seller):

iltom Poznańska 122a 63-800 Gostyń iltom@iltom.pl

I/We(*) hereby give notice of my/our(*) withdrawal from the contract of sale of the following goods(*) / for the supply of the following service(*):

Order number (if applicable):

Date of contract(*) / receipt(*):

Name of consumer(s):

Address of consumer(s):

Signature of consumer(s) (only if this form is notified on paper):

Date:

(*) Delete as appropriate.

Print the completed form and send it by post to the seller's address, or scan it and send it to the email address provided above.

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