Withdrawal Form
Withdrawal Form
(If you want to withdraw from your oder, please print and complete this form, then send it to us)
Att. / An
Douro & Porto / Vinum Mundi
Eric van Crombrugge
Osnabrücker Weg 27
33378 Rheda-Wiedenbrück
E-Mail: info@vinum-mundi.com
Herewith I cancel the contract over following goods
_______________________________________________
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Ordered on ___________________ (*)/ received on _______________________(*)
Name of consumer ______________________________________
Address of consumer _________________________________
_________________________________
_________________________________
_________ _____________________________________________________
Date Signature