To the attention of: Aurora Flame / Alae Capital Ltd
Address:
PO Box 30236, RPO OGILVIE
Whitehorse, Yukon Territory, Y1A 5M2
Canada

Seller’s email address: contact@aurora-flame.com

I hereby notify you of my withdrawal from the contract for the sale of the product listed below:

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Product reference / name: ______________________________________

Order number: ________________________________________________

Ordered on (date): ____________________ Delivered on (date): ____________________

Payment method used: __________________________________________

Customer name (and, where applicable, the name of the person who received the order):

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Customer address:

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Customer signature (unless submitted by email):

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Date: ____________________