Cancellation form

Model withdrawal form
 
(If you want to cancel the contract, please fill out this form and send it back.)
 
Please send to:
Nouveaux Etablissements Charles Martin SA
Rue Joseph Martin, 35
4450 Lantin, Belgium
 
E-Mail: info@martinsystem.com
 
- I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of the following goods (*) / the provision of the following service (*)
 
- Ordered on (*) / received on (*)
 
- name of the consumer (s)
 
- address of the consumer (s)
 
- Signature of the consumer (s) (only when notified on paper)
 
- date

___________

(*) Delete as appropriate.