Withdrawal form

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

TO:
Nayan
Pittemsestraat 58d
8850 Ardooie (Belgium)
Fax : +32 51 696 837
customer.care.ie@americantourister.com

I/We(**) hereby give notice that I/We(**) withdraw from my/our(**) contract of sale of the following goods (**)/for the provision of the following service(**).

(**) Delete as appropriate.