Order Cancellation Form
Fill out this form in order to cancel your contract of sale for the following goods/services:

Pangaea Laboratories Ltd. (Nanogen.com)
730 Centennial Park
Elstree, Herts.
WD6 3SZ
020 8458 2500
support@nanogen.com

I would like to cancel an order *
After submitting this form, you will be issued a Returns Number and details of how to return the goods for a refund.
Required
My full name is *
Your answer
My full address is *
Your answer
My email or phone number
We may need to contact you to process this cancellation, please enter either your email address or phone number
Your answer
I wish to cancel the following order number *
Type the order number you wish to cancel below
Your answer
Date of the above order number *
MM
/
DD
/
YYYY
To sign this form, please type your name with forward slash before and after. *
eg. /John Smith/ or /Jane Mary-Doe/ or /Mrs K.A. Patel/
Your answer
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