Withdrawal Form Sample 

(Complete and return this form only if you wish to withdraw from the contract)

To:

• Company Name: [Gunta Graudiņa]

• Legal Address: [Ģērnmaņi, Suntaži, Ogres nov]

• E-mail Address: [peonija92@gmail.com]

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

• Order Date: [DD.MM.YYYY]

• Date of Receipt: [DD.MM.YYYY]

• Order Number: [#1001]

• Item Name(s) and Quantity: [INSERT ITEM NAME(S)]

Consumer Details:

• Consumer Name & Surname: [FIRST NAME, LAST NAME]

• Consumer Address: [ADDRESS, CITY, POSTAL CODE, COUNTRY]

• Consumer E-mail Address: [EMAIL ADDRESS]

• Consumer Phone Number: [PHONE NUMBER]

• Bank Account Number (IBAN) for Refund: [LVXX XXXX XXXX XXXX XXXX]

Date: [DD.MM.YYYY]

Consumer Signature: ______________________ (only if this form is submitted on paper)