If you would like to withdraw from your contract with us, please complete this form and send it back to us: either at our address: Beyond Retro Limited, Customer Care, 92-100 Stoke Newington Rd, London, N16 7XB. or scanned/photographed by E-Mail: [email protected] I would like to withdraw from my contract for the purchase of goods as listed:_____________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________ (* list items for which you wish to withdraw) Order Number ____________________(* Please give us the Order Number this relates to which you will find on your confirmation of order email or within your account details) (*) Bought on _________________(*date) /delivered on :______________(*date): Customer Title______________________________________ Customer Name______________________________________ Customer Signature____________________________________ (No need for signature unless returning this form by hard copy) Date _______________________________________________ (*) Complete or delete as applicable.