To
fallalarm.co.uk
Vaclav Jelinek
Am Pfingsberg 2A
40882 Ratingen
Fax:
E-Mail: infonospamplease@nospampleasefallalarm.co.uk
I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),
Ordered on (*)/received on (*)
Name of consumer(s)
Address of consumer(s)
Signature of consumer(s) (only if this form is notified on paper)
Date
(*) Delete as appropriate.