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Withdrawal form

Attention:

STARCK GALLERY SL
Carrer Martin i Soler, 5
Elche Parque Empresarial
03203 Elche
Spain
Email: info@starck-gallery.com

I hereby notify you of my withdrawal from the contract for the sale of the goods below:

Order no.: ______________________
Order date : ______________________
Date received: ______________________

Customer name : ______________________
Customer address : ______________________
____________________________________
____________________________________

Product(s) concerned:
____________________________________

____________________________________

Possible reason for return - optional:
____________________________________
____________________________________

Date of return : ______________________

Customer's signature
only if sent on paper :

______________________

Nos Artistes

10 voix singulieres, representees par Starck Gallery a Elche

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