Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

To GSC - Partenerul tau in IT&C, Str. Lt. Petre Lintes nr 39 sector 5, 050871 BUCURESTI, rb@entex.ro:

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: