If you want to cancel this contract, please complete and return this form.
Jacqueline Passow Delaye
I/ We hereby give notice of cancellation from my / our contract, entered into for the purchase of the following goods (*) / provision of the following service (*):
Ordered on / received on :
Customers’ name (s):
Customers’ address (es):
Customers’ signature (s) (only for paper based notifications):