OPTIONAL CANCELLATION FORM — MOMENTANTHEM

Send only if you wish to cancel. You can also use any clear statement.

To: Jakub Smejkal, trading as MomentAnthem
IČO: 04457609
Velatice 212, 664 05 Velatice, Czech Republic
Email: support@momentanthem.com
Phone: +420 736 264 054

I give notice that I wish to cancel my contract for the following
personalized-song service / digital content:

Order reference:
Date ordered:
Customer name:
Purchase email:
Customer address (if needed to identify the contract):
Date of this notice:

Signature (only if sent on paper):

You do not need to give a reason when exercising a statutory cancellation
right. Please do not include card details or passwords.