WITHDRAWAL FORM — ALPAKA MUZIK EUROPE

Complete and send this form only if you wish to withdraw from your purchase.

To: PLANET B / ALPAKA MUZIK Europe, Heiamyrå 16 A, 4033 Stavanger, Norway

Email: poe.power.no@gmail.com

I/We hereby give notice that I/we withdraw from my/our contract of sale of the following goods:

Goods: ___________________________________________

Order reference (if available): ___________________

Ordered on: ____________ / Received on: ____________

Name of consumer(s): ______________________________

Address of consumer(s): ___________________________

__________________________________________________

Date: ____________________________________________

Signature of consumer(s) (only if sent on paper):

__________________________________________________

Delete whichever does not apply.