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WITHDRAWAL FORM

MODEL WITHDRAWAL FORM

(This document or letter should only be completed and sent if you wish to withdraw from the contract)

Subject: Withdrawal of the contract

In: …………………………… .., at …………. / …………… / ………….

For the attention of:

Emilio José Prados Paredes

NIF: 47649033W

C / Comerç 3 1-1

08800 Vilanova i la Geltrú

Barcelona

Phone: 611077927

Email: web@origenn.com

Owner of the following online commerce website: www.origenn.com

By means of the present, I / we put in your knowledge my / our will to DESIST of our contract of sale of the following goods or products:

Type of product (s) and description of the same (s) (include, where appropriate, the reference number):

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………
Order number: ……………………………………

Date on which the order was placed or signed: ………………………………………………

Date of receipt of the order: …………………………………………………………………………

Name and identity document (DNI / NIE / Passport) of the consumer (s) and user (s) (a copy is attached):

…………………………………………………………………………………………………………………………



Address of the consumer (s) and user (s):

…………………………………………………………………………

Telephone of the consumer (s) and user (s):

…………………………………………………………………………………………………………………………

Email of / the consumer (s) and user (s):

…………………………………………………………………………………………………………………………

Name and address of the recipient of the shipment (only if the address is different from that of the consumer (s) and user (s)):

…………………………………………………………………………………………………………………………



……………………………………………… ..
Signature of the consumer (s) and user (s)
(Only if the form is submitted on paper)

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