SELLISHOT — MODEL WITHDRAWAL FORM
Complete and return this form only if you wish to withdraw. You may instead send any clear withdrawal statement.

To: Sofiane Łaba (Fianso), Leśmiana 9/29, 80-280 Gdańsk, Poland
Email: support@fiansodev.com

I/We (*) hereby give notice that I/we (*) withdraw from my/our (*) contract for the sale of the following goods (*) / supply of the following goods (*) / work to produce the following goods (*) / provision of the following service (*):

Sellishot purchase/service: ______________________________
Ordered on (*) / received on (*): _________________________
Name of consumer(s): ____________________________________
Address of consumer(s): _________________________________
Signature of consumer(s) (only if sent on paper): _________
Date: ___________________________________________________

(*) Delete as appropriate.