(You should only complete and return this form if you wish to withdraw from the contract)

------------ To Página Fugitiva LDA., a legal entity with NIPC 518447693, headquartered at Avenida
São Lourenço 225, 4705-445 Celeirós – Braga.
------------- I hereby notify you of my decision to withdraw from the purchase and sale contract
relating to the following order: __________________ (order number).

------------Purchased on: ________/_________/_______ (order date) by:
_________________________________________________________
(name as stated on the order)
Address: ____________________________________________________________

Signature:
_____________________________________________________