Model withdrawal form

Model withdrawal form

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

On
Mellody Casuals V.O.F.
Vestiging- & bezoekadres:
Rijswijkstraat 185 Unit 153
1062 EV Amsterdam
Nederland
T: +31 – (0)20 – 615 48 53
M: +31 – (0)6 – 54 78 31 27
Emailaddres: Info@Mellodycasuals.nl
Kvk- nummer: Amsterdam 33249760
Btw- identificatienummer: NL.815060142 B01

    I / We (*) part / parts (*) hereby give notice that I / We (*) withdraw from my / our contract for the sale of the following goods / provision of the following services (*) (*):

    Ordered on (DD-MM-YYYY) :

    Received on (DD-MM-YYYY):

    Order number :

    Name / s consumers(en)

    Address of consumer (en) :

    IBAN bank account:

    On Hand drawing from consument(en) (only if this form is notified in writing)

    Date(DD-MM-YYYY):