Model withdrawal form
(If you want to cancel the contract, please fill out this form and send it back.)

• To Vipergear, Diezestraat 5, 9406 RD, Assen, The Netherlands Telephone: +316-82285413, Email: sales@vipergear.eu
• I / we () hereby revoke the contract concluded by me / us () for the purchase of the following goods () / the provision of the following service ()
• Ordered on () / received on ()
• name of the consumer (s)
• address of the consumer (s)
• Signature of the consumer (s) (only when notified on paper)
• date

(*) Delete as appropriate.