Withdrawal Form

Complete and return this form only if you wish to withdraw from the contract or purchase

• FLORIUM SERVICE LLC, MARIIA ZAZULYA SOLE MBR, 2222 W GRAND RIVER AVE STE A, OKEMOS, MI 48864, Email: [email protected]
• I/We (*) hereby give notice that I/We (*) withdraw from my/ our (*) contract for the provision of the following service/product:
• 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.