Model Withdrawal Form
Effective Date: 23 July 2026
Last Updated: 23 July 2026
(Complete and return this form only if you wish to withdraw from the contract.)
Recipient
For purchases where OVGC Payment Services FZ-LLC acted as the Merchant of Record, please submit this form using the contact details provided in your order confirmation, invoice or other transaction documentation.
For product-related enquiries, you may also contact:
BellTower
Owner: Matthias Daniel Schmid
c/o Postflex #5438
Emsdettener Str. 10
48268 Greven
Germany
E-Mail: [email protected]
Withdrawal Declaration
I / We (*) hereby give notice that I / We (*) withdraw from my / our (*) contract relating to the purchase of the following goods (*) / the provision of the following service (*):
Order Information
| Order Number | |
| Product(s) | |
| Date Ordered | |
| Date Received |
Customer Information
| Full Name | |
| Street Address | |
| Postal Code / City | |
| Country | |
| E-Mail Address |
Optional Information
The following information is optional but may help us process your request more efficiently.
| Reason for Withdrawal (optional) | |
| Preferred Contact Method |
Declaration
I confirm that I wish to exercise my statutory right of withdrawal where applicable.
| Date | Signature (only if submitted on paper) |
Instructions
- Completion of this form is voluntary.
- You may instead submit your withdrawal using any clear written declaration.
- The form must be submitted before the applicable withdrawal period expires.
- Where OVGC Payment Services FZ-LLC acted as the Merchant of Record, withdrawal requests relating to the purchase transaction should normally be directed using the contact details supplied with your order.
- Additional information is available in the Withdrawal Instructions and the Refund & Cancellation Policy.
(*) Delete or complete as appropriate.
Version Information
Document: Model Withdrawal Form
Version: 3.0
Effective Date: 23 July 2026
Last Updated: 23 July 2026