Model Cancellation Form

Complete and return this form only if you wish to cancel the contract:

— To Mixing Out Limited, 111 Ladybank Road, Mickleover, Derbyshire, DE3 0PF, UK

— I/We [*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods[*]/for the provision of the following service [*],

— Ordered on[*],

— Name of consumer(s),

— Address of consumer(s),

— Signature of consumer(s) [only if this form is notified on paper],

— Date