Returns Form
(Complete and return this form only if you wish to withdraw from the contract)
To Samuel Brothers (St Paul’s) Ltd
Heath House
Suite Two
227-229 Frimley Green Road
Frimley Green
Surrey
GU16 6LD
Tel No: 01252 838140
Email: store@samuelbrothers.co.uk
I/We [*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*]/for the supply of the following service [*],
Ordered on [*]/received on [*],
Name of consumer(s),
Address of consumer(s),
Signature of consumer(s) (only if this form is notified on paper),
Date
[*] Delete as appropriate
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