Withdrawal Form

[Your First Name]
[Your Surname]
[Your Organization Name]
[Your organization Address]
[City, State ZIP Code]


To: New Impact Academy
I hereby give notice that I withdraw from my contract of purchase of the following course(s) from New Impact Academy:

Course Name: [insert name of course(s)]
Order Number: [insert order number]

Name: [insert your name]
Address: [insert your address
] Email Address: [insert your email address]
Date of Purchase: [insert date of purchase]

I am requesting a refund of the purchase price paid for the course(s) within 14 days of this notice. I confirm that I have not downloaded or accessed any course materials.


[Your Name]

You can also download the document here.

(for the PDF version, click here

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