Returns Form

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


To        Samuel Brothers (St Paul’s) Ltd

Unit 3   Elliott Park

Eastern Road



GU12 4TF


Tel No:  01252 838140


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),










[*] Delete as appropriate

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