Model Withdrawal Form
Download the form
Would you prefer to download and complete the form? Download the multilingual model withdrawal form below.
Complete and return this form only if you wish to withdraw from the contract.
To:
PATRICE FRANSEZ
Koolmijnlaan 146/1
3550 Heusden-Zolder
Belgium
Email: info@patricefransez.com
I/We (*) hereby give notice that I/we (*) withdraw from my/our (*) contract for the sale of the following goods (*) / provision of the following service (*):
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Ordered on (*) / received on (*):
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Name of consumer(s):
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Address of consumer(s):
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Order number (if available):
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Signature of consumer(s):
(only if this form is submitted on paper)
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Date:
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(*) Delete as appropriate.
Prefer to return online?
You do not have to use this model form to register a return with PATRICE FRANSEZ. You can also easily register your return online using our return form.
For return conditions, deadlines and information about free returns, please see our Return and Refund Policy.