(just fill in and send this form if you wish to withdraw from the contract)

-To the attention of D'TORRES CALZADO ORTOPEDICO, S.L. CALLE SEGORBE, 31 03206 ELCHE (ALICANTE) SPAIN , PHONE +34 965 442040, FAX +34 965 464542,  E-mail info@dtorres.com
-Hereby contact you / communicate (*) which desisto of mi / motions of our contract for sale of the following good/provision of the following service (*) (*)

-Order/received the (*)
-Name of user and consumer or consumers and users
-Domicile of the consumer / user or of consumers and users
-Signature of the consumer / user or of consumers and users (only if this form is presented in paper)
-Date

(*) Delete as appropriate.

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iqitcookielaw - module, put here your own cookie law text