Gold Vision Communications - Hosting & Virtual Dedicated Servers

Model withdrawal form

Complete and return this form if you wish to withdraw from the contract. To Gold Vision Communications, Inc. 701 S. Carson Street, Ste. 200-2367 Carson City, NV 89701, USA Phone: +1-775-473-9956 E-Mail:
I/We () hereby give notice that I/We () withdraw from my/ our (*) contract for the provision of the following service:
Ordered on ()/ received on ()
Name of consumer(s)
Address of consumer(s):
Date, City:
Signature of consumer(s) (only if this form is notified on paper)

(*) Delete as appropriate.