To Levi Solicitors LLP, 33 St Paul’s Street, Leeds LS1 2JJ, telephone number 0113 244 9931, fax 0113 2971872, email info@levisolicitors.co.uk.

I/We* hereby give notice that I/we* cancel my/our* contract for the supply of the following service

[ insert description of legal service]

Ordered on  [insert date]

Name of consumer

Address of consumer

Signature of consumer (s)  [only if this form is notified on paper]

Date

*delete as appropriate