Module type for the exercise of the right of withdrawal

Dear

Nonno Mario Italia Snc

Via Neive 65

12050 Castagnito d'Alba CN

hereby notified my withdrawal from the following purchase order:

Order no.__________________________

Order date_____/__/____

Reception date _____/__/____

Name of the person who placed the order: __________________________________________________

Shipping address order: __________________________________________________

__________________________________________________

__________________________________________________

Bank details for the refund (Complete only if payment is made by bank transfer):

IBAN __________________________________________________

BIC/SWIFT :  ________________________________

Bank __________________________________________________

date___/__/____

Signature

________________

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