Withdrawal Form

Right of Withdrawal Notification Form
(Complete and send this form if you wish to withdraw from the contract and return the product.)

Customer Information:

• Full Name:

• Address:

• Phone Number:

• Email Address:

Order Information:

• Order Number:

• Order Date:

• Delivery Date:

• Product(s) to be Returned:

• Reason for Return (optional):

Return Preference:

• Refund

• Exchange (Subject to availability)

Bank Information (If refund is to be made via bank transfer):

• Bank Name:

• IBAN Number:

• Account Holder Name:

Signature (only if submitting a paper form):

Date: ____ / ____ / ______

Return Address:
NIVELLE PARFUM
Transtigen 20, 26241, Sweden
nivelleparfum@gmail.com