model termination form

Only complete and return this form if you wish to terminate or withdraw the agreement.
product(s)*I'm informing you with this form that I wish to withdraw the agreement concerning the sale of the following goods
date of purchase*
product was received on*
your information
preamble*
full name*
address 1*
address 2
zip code*
city*
state
country*
telephone number*Providing us with a telephone number and the times you can be contacted, this will allow us to assist you faster.
Please, leave this field empty.
nothing looks, rides, lasts like a van nicholas