Withdrawal sample form

Withdrawal sample form

withdrawal form

You can here download that form as PDF or WORD file

(If you want to cancel the contract, please fill out this form and send it back.)


Company sklo Lustry s.r.o.

Na Vyhlidce 73

36007 Karlovy Vary / CZ

Czech Republic


Fax: 00420 353 228 183


Hereby give notice (s) I / We (*)

withdraw from my / our (*)

concluded contract about the purchase of the following products (*)

Ordered on (*)

received at (*)


Name / consumer (s)

Address of / consumer (s)


Signature / consumer (s) (only with message on paper)





(*) Delete as appropriate.