top of page

Withdrawal form

(Only fill out and return this form if you want to cancel the contract)

- To ([name and address of the shop]), telephone number: [please state your telephone number], fax number: [please state your fax number], email address: [please state your email address], fax number: [please state your fax number ], E-mail address: [Please enter your e-mail address].

- I / we (*) hereby inform you that I / we (*) cancel my / our (*) purchase contract for the following goods (*) / for the provision of the following services

- Ordered on (*) / received on (*)

- Name of the customer

- Address of the customer

- Signature of the customer (only if this form is sent in paper form)

- Date


(*) Delete what does not apply.

bottom of page