Form for dissolution/revocation


Only complete this form and return it if you have

to cancel/revoke the agreement.


Idee voor

Iependaal 210

3075 WR Rotterdam

Phone number: 06-29524376



Hereby I/We (*) inform you that I/we (*)

recall/revoke (*) our agreement regarding the sale of

the following goods/delivery of the next service:


Ordered on Date:

Received on :

Name/Names recipient:

Address receiver:

Street name :

Postal Code :

Residence :

E-mail :

Signature of recipient: *





(* Signature only when this form is submitted on paper)




Download Revocationform