Right of Withdrawal Form

To the attention of:

Name: MEDVISIT, S.L.U. Tax ID No.: B66234949
Address: Calle Bilbao, 110 – 23 4 08018 BARCELONA (Barcelona) Town: BARCELONA
Telephone: 689327144
E-mail: [email protected]

Details of the good/provision to be withdrawn:

No. contract/order/invoice:
Contract/order/invoice date:
Date of receipt of the product/service:
Description of the product/service:

Consumer/user data:

* Telephone:
* E-mail:
(* data not obligatory)

Right of withdrawal:

You may exercise the right of withdrawal within the period of 14 days established by law from the day following the date of a service contract or the day of receipt of a product.

In accordance with Article 71 of Law 3/2014 of 28 March, which amends the revised text of the General Law for the Defense of Consumers and Users and other complementary laws, I hereby inform you that I withdraw from the contract of sale of the good/provision described above within the established term, so I would be grateful if you would contact me using the contact details provided, to notify me that this request has been proceeded with.

Date of request:

Signature of consumer/user: