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 Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

To Supply1
Avenue House
3 David Road
Poyle Industrial Estate Colnbrook
London Heathrow
SL3 0TW


I/We [*] hereby give notice that I/We [*] withdraw from my/our [*] contract of sale of the following goods:


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
AUTHORISED DISTRIBUTOR FOR...