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Model withdrawal form

Appendix I:Model withdrawal form

Model withdrawal form

(only complete and return this form if you wish to cancel the contract)

Murmanskweg 2 Unit 11C
9723 HM Groningen

+31 85 303 71 55

  • I/We * share/share * hereby inform you that I/we * regarding our agreement

the sale of the following products: [product description] *

the delivery of the following digital content: [indication of digital content] *

the provision of the following service: [specification of service] *,

revoke/revoke *

  • Ordered on */received on * [date of order for services or receipt for products]
  • [Name of consumer (s)]
  • [Address of consumer (s)]
  • [Signature of consumer (s)] (only if this form is submitted on paper)

* Delete what does not apply or enter what applies.