MODEL WITHDRAWAL FORM

Name

Your e-mailadres

Subject

Ordered on

Received on

I/We (*) hereby share (*) with you that I/we (*) am/are revoking/revoking our agreement regarding the sale of the following goods (*)/provision of the following service (*)

Explanation of withdrawal (please fill in which product(s)/service(s) it concerns)

The undersigned declares that this form has been completed truthfully.