CANCELLATION FORM

To Energy for Health Ltd of 18A Atlantic Road, Weston-super-Mare, BS23 2DQ, United Kingdom / info@energyforhealth.co.uk.

I/We* hereby give you notice that I/We* cancel my/our* contract for the sale of the following goods*/for the supply of the following service*:

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