Form of Withdrawal

 

Complete and submit this form only if you intend to withdraw from the contract

RECIPIENT: Andolfo Daniel, Piazza A. De Gasperi, 41 / 35131 B Padova CF NDLDNL78T29A182G VAT 04682380284, n. REA 410032, tel. 049 8784992 0429 779830 fax;

Hereby I (Surname)________ (Name) _________ resident (Street / square) ______________ No. __ CAP _______ _____________ city prov. (__)
email address _____________ notified the termination of my contract of sale of the following goods and services:

Ordered / the day __ / __ / ____ and received / the day __ / __ / ____

 

 

Authorize the crediting of the amounts paid with the sole exception of expenses of return on my bank account IBAN ________________________

 

Date

 

 

Company (only if the form is notified on paper)

 

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