Withdrawal Form

(If you wish to withdraw from the contract, please complete this form and return it to us.)

To:

IQ+ Helena Gržinić Venier
Červar-Porat 22
52440 Poreč
Croatia
E-mail: info@heleny.de

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

Ordered on (*): ___________________________

Received on (*): ___________________________

Name of consumer(s): ___________________________

Address of consumer(s):

Signature of consumer(s) (only if this form is notified on paper):

Date: ___________________________

(*) Delete as appropriate.