Withdrawal Form
(If you want to cancel the contract, please fill out this form and send it back.)
To:
ePropelled Inc.
144 Lexington Drive
Laconia, NH 03246
USA
E-Mail: info@epropelled.com
Telephone: +1 (603) 236-7444
(Company contact details from the official ePropelled website.) (ePropelled)
I/We () hereby withdraw from 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 consumer(s)
Address of consumer(s)
Signature of consumer(s) (only if notified on paper)
Date
(*) Delete as appropriate.
