Cancellation Form

MODEL CANCELLATION FORM

(See the Cancellation and Returns – Your Rights as a Consumer section)

(Complete and return this form only if you wish to withdraw from the contract)

To MALONE SOULIERS, TOP FLOOR, 49 ALBEMARLE STREET, LONDON W1S 4JR, ENGLAND (or email it to IT@malonesouliers.com)

I/We [*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*]: ________________________________

Ordered on [*]/received on [*]:________________________________

Name: ________________________________

Address: ________________________________

Signature (only if this form is notified on paper): ________________________________

Date: ________________________________

[*] Delete as appropriate