I/We[*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*] [for the supply of the following service [*], Ordered on [*]/received on [*]______________________(date received) 
  
  
  Name of consumer(s): 
  
  
  
  Address of consumer(s): 
  
  
 

 

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

 

Date

 
   
  [*] Delete as appropriate.