Withdrawal Application

Withdrawal Application

Only fill in and return this application if you wish to withdraw from the contract!

Withdrawal statement

Borsa Eesti OÜ, 76605 Keila, Harjumaa, Estonia

E-mail address: [email protected]

 

 

I hereby withdraw from the contract whose object (s) is (are) the order ................................ (Order number) on the basis of the purchased product / products:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

I have received the order .... / ..... / ................ (date, month, year)

 

 

Customer name:

Customer address:

Customer signature

(if this application is submitted on paper)

Date