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(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
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.