Withdrawal form

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

TO:
Frucon²
Pittemsestraat 58d
8850 Ardooie (Belgium)
Fax : +32 51 696 837
customer.care@hartmann.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(*).

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:


Please fill in all mandatory fields.

(*) Delete as appropriate.