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

_______________________________________________

_______________________________________________

 

Ordered on ___________________ (*)/ received on _______________________(*)

 

Name of consumer  ______________________________________

Address of consumer _________________________________

_________________________________

_________________________________

 

_________                    _____________________________________________________

Date                          Signature

 

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