Sample cancelation form

(If you wish to cancel the Agreement, please complete this form and return it.)

- To

Usenet.nl S.r.l.

Piazza Enrico Enriquez 22

47891 Dogana

San Marino

E-Mail: info@usenet.nl

- I/we (*) hereby cancel the Agreement entered into by me/us (*) for the provision of the following

service (*)

- Ordered on (*)/received on (*)

- Name of consumer(s)

- Address of consumer(s)

- Signature of consumer(s) (only where notification is on paper)

- Date

___________

(*) Delete if inapplicable.

End of sample cancelation form