Model Withdrawal Form

This form is for consumers only (see section 14 of our Terms and Conditions). Fill it in and send it only if you want to withdraw from the contract. You may also send your own statement.

To:
YOURWiFi s.r.o.
Českodubská 784, 190 17 Praha 9, Czech Republic
E-mail: wifi@yourwifi.cz

I hereby give notice that I withdraw from my contract for the purchase of the following goods:

Goods: ______________________________

Order number: ______________________________

Ordered on: ____________   Received on: ____________

Name of consumer: ______________________________

Address of consumer: ______________________________

Bank account for refund (if you paid by bank transfer): ______________________________

Date: ____________

Signature (only if you send this form on paper): ______________________________