MODEL WITHDRAWAL FORM

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

To: EWA LITKE-BAK, Av. Heydenberg 23, 1200 Woluwe-Saint-Lambert / 

Email: hello@ewalitke.com   

I hereby give notice that I withdraw from my 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: ……..…………………………………………………………………………………………………

​​​​​​​​​___________________

(*) Delete as appropriate.