Withdrawal Form

To: NETGATE Technologies s.r.o., Tajovskeho 8, 97101 Prievidza, support@netgate.sk

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):

Date:

Your e-mail: