Annex B — Model Cancellation Form

For consumer orders placed online/at a distance. Use this form only if you wish to cancel the contract within your statutory cooling-off period.

Nothing in this Schedule affects your statutory rights as a consumer.

To:

  • Pretium Synergy Ltd
  • Website: https://pretiumsynergy.co.uk
  • Email: [insert cancellations email]
  • Postal address: [insert full postal address for returns/correspondence]
I/We hereby give notice that I/We cancel my/our contract for the supply of the following goods/services:
  • Order number: __________________________
  • Product(s)/Service(s): __________________________
  • Ordered on / received on (delete as appropriate): ____ / ____ / ______
  • Customer name: __________________________
  • Customer address: __________________________
  • Customer phone/email: __________________________
If goods have been delivered:
I will send the goods back without undue delay and no later than 14 days from the day I told you I was cancelling.
  • Address for returns (if different): __________________________
  • Preferred collection (if applicable and agreed): __________________________
Signature (only if this form is notified on paper): __________________________
Date: ____ / ____ / ______