(complete and return this form only if you wish to withdraw from the contract).
To: NETGATE Technologies s.r.o., Tajovskeho 8, 97101 Prievidza, email@example.com
I hereby give notice that I withdraw from my contract of saleWe hereby give notice that We withdraw from 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):