To George Cox Footwear Limited (company number 12727611), with registered office at 37 Mount Pleasant, Clerkenwell, London, England, WC1X 0AA.
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 [*]
Order Number
Ordered on [*]/ received on [*]
Name of consumer(s)
Address of consumer(s)
Signature of consumer(s) (only if this form is notified on paper)
Date
[*] Delete as appropriate