DearDEMENEGOs.r.l.

ViaNazionale,49,32042

CalalzodiCadore(Belluno)–ITALY

I,theundersigned____________________________________Address_________________________________________

city______________________________Bymeansofthepresent,doherebynotifymyintentionto

withdrawfromthesalescontractrelatingtothefollowinggoods:

Ordern°___________________________

Productname___________________________

Productcode___________________________

Colour___________________________

Orderedon___________________________

Receivedon___________________________

Date Signature