Notice of Cancellation
_________________________(Date of Transaction)
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to _________________________ (name of seller), at _________________________ (address of seller's place of business) not later than midnight of ____________________ (Date).
I hereby cancel this transaction.
_________________________(Date)
________________________________________(Buyer's signature)"; or
Va. Code § 59.1-21.4