{load_language_text section="withdrawal"}
<span style="font-size: 12px;"><b><u>{$txt.withdrawal_form}</u></b><br /><br /></span>
{$txt.withdrawal_hint}
<br /><br /><br />
{$txt.to}:
&nbsp;<br />&nbsp;<br />
{$smarty.const.COMPANY_NAME}<br />
{$smarty.const.TRADER_FIRSTNAME} {$smarty.const.TRADER_NAME}<br />
{$smarty.const.TRADER_STREET} {$smarty.const.TRADER_STREET_NUMBER}<br />
{$smarty.const.TRADER_ZIPCODE} {$smarty.const.TRADER_LOCATION}<br />
{$smarty.const.STORE_COUNTRY_NAME}<br />
{if $smarty.const.TRADER_FAX != '' || $smarty.const.STORE_OWNER_EMAIL_ADDRESS != ''}
&nbsp;<br />
{/if}
{if $smarty.const.TRADER_FAX != ''}
{$txt.fax}: {$smarty.const.TRADER_FAX}<br />
{/if}
{if $smarty.const.STORE_OWNER_EMAIL_ADDRESS != ''}
{$txt.mail}: {$smarty.const.STORE_OWNER_EMAIL_ADDRESS}
{/if}
&nbsp;<br />&nbsp;<br />&nbsp;<br />
{$txt.withdrawal_products_hint}
&nbsp;<br />&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />&nbsp;<br />&nbsp;<br />
{$txt.ordered_on} / {$txt.delivered_on}
&nbsp;<br />&nbsp;<br />&nbsp;<br />&nbsp;<br />
{$txt.first_last_name}
&nbsp;<br />&nbsp;<br />
<HR>
&nbsp;<br />&nbsp;<br />&nbsp;<br />
{$txt.address}
&nbsp;<br />&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />
<HR>
&nbsp;<br />&nbsp;<br />
&nbsp;<br />&nbsp;<br />
______________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;_____________________________________________________
&nbsp;<br />&nbsp;<br />
{$txt.date}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{$txt.signature}
&nbsp;<br />&nbsp;<br />&nbsp;<br />&nbsp;<br />&nbsp;<br />
<HR>
&nbsp;<br />
{$txt.pdf_form_hint}