Model Withdrawal Form

Use of this model form is optional. You may instead send any other clear statement that you wish to withdraw from the sales contract. For the online route, use Withdraw from contract.

Model withdrawal form

To:
MB “Nirista”
Gedminų g. 2-121
LT-94167 Klaipėda
Lithuania
Email: support@againora.com

I/We hereby give notice that I/We withdraw from my/our contract of sale for the following goods:

Order number: __________________________________________

Description of the goods:
________________________________________________________________
________________________________________________________________

Order date: _____________________________________________

Delivery date: __________________________________________

Customer's full name: ___________________________________

Customer's address:
________________________________________________________________
________________________________________________________________

Customer's email: _______________________________________

Signature: ______________________________________________
Required only where this form is submitted on paper.

Date: ___________________________________________________

Send the completed form by email to support@againora.com or by post to the address above. Keep a copy and evidence of sending.