Withdrawal Form
Recipient:
Loft Health & Beauty
2a Mill Square, Raceview Mill
Broughshane BT42 4JJ
I, [your name], hereby inform you of my withdrawal from the contract for the purchase of the following goods: [list products].
Date of order: [date], date of receipt: [date].
Please refund the amount to: [bank account number].
Date: [date]
Signature: [only if sent in paper form]