Model form for revocation
(Complete this form only and return it if you want to revoke the agreement)
De Hollandse Klompenwinkel
Vrouwkensvaarsestraat 29
5165 NN Waspik
[email protected]
+31416854853
KVK NUMBER 61899062
VAT NUMBER NL189267744B01
- I / We (*) share / (*) hereby inform you that we / we (*) revoke / revoke our agreement on the sale of the following goods / delivery of the following service (*):
- Ordered on (DD-MM-YYYY):
- Order number:
- Received on (DD-MM-YYYY):
- Name / Name of consumer (s)
- Consumer Address (s):
- IBAN bank account:
- Signature of consumer (s) (only when this form is submitted on paper)
- Date (DD-MM-YYYY):
(*) Cross out what is not applicable.