NOTICE OF CANCELLATION
Date of transaction ___________________________
You may cancel this transaction, without any penalty or obligation, within three business days (five
business days for Alaska residents) from the above date.
If you cancel, any property traded in, any payments made by you under the contract or sale, and any
negotiable instrument executed by you will be returned within 10 business days following receipt by the
seller of your cancellation notice, and any security interest arising out of the transaction will be canceled.
If you cancel, you must make available to the seller at your residence, in substantially as good condition
as when received, any goods delivered to you under this contract or sale; or you may if you wish, comply
with the instructions of the seller regarding the return shipment of the goods at the seller’s expense and risk.
If you do make the goods available to the seller and the seller does not pick them up within 20 days of the
date of your notice of cancellation, you may retain or dispose of the goods without any further obligation.
If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail
to do so, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other
written notice to __________________________________, at __________________________________ not
later than midnight of ____________________.
I hereby cancel this transaction.
Buyer’s signature __________________________________ Date ___________________________
PRODUCT SALES RECEIPT (CONTINUED)
MODERE PRODUCT SALES RECEIPT • ITEM CODE #20001 • 09/13
Modere • 588 S. 2000 W. • Springville, UT 84663 • Toll Free Customer Service 855-663-3731 • Fax 800-998-7260
NAME OF SELLER ADDRESS OF SELLER’S PLACE OF BUSINESS