Model withdrawal form

1. How to use this form

This model follows Part B of Annex I to Directive 2011/83/EU. Complete and send it only if you are a consumer and wish to withdraw from the contract. Use of the form is optional; any other unequivocal statement is also sufficient.

2. Addressee

ILICO Europe s.r.o., Nová Draha 451, 270 54 Řevničov, Czech Republic; email info@visionbutler.com. After prior arrangement, return goods to Zábořská 93, 539 44 Proseč, Czech Republic.

3. Notice

I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods: VisionButler, variant/size/colour ______________________________.

4. Order details

• order number: ______________________________;
• ordered on: ______________________________;
• received on: ______________________________.

5. Consumer details

• name: ______________________________;
• address: ______________________________;
• date: ______________________________;
• signature (only if this form is submitted on paper): ______________________________.