WITHDRAWAL FORM


(complete and return this form only if you wish to withdraw from the contract)
Recipient:
Pernarcic Alessandro
Via Roma 72 Meolo VE 30020 IT
info@balancershop.com
With this form I notify the withdrawal from my sales contract of the following goods / services:
______________________________________________
______________________________________________
______________________________________________
Ordered on: ______________________________________________
Received on: ______________________________________________
Consumer Name: ______________________________________________
Consumer Address: ______________________________________________
Consumer's signature: _______________________
(only if the form is sent in paper version)
Place and date: _______________________

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