Model form for withdrawal
(Only complete and return this form if you want to withdraw from the agreement. You can read more information about this in our General terms and conditions )
a. To: [ name of entrepreneur]
[ geographical address of entrepreneur]
[ fax number of entrepreneur, if available]
[ email address or electronic address of the entrepreneur]
b. I/We* hereby inform you that I/we* have terminated our agreement regarding
the sale of the following products: [product designation]*
the supply of the following digital content: [designation of digital content]*
the provision of the following service: [designation of service]*,
revoked/revoked*
c. Ordered on*/received on* [date of order for services or receipt of products]
d. [Name of consumer(s)]
e. [Consumer(s) address]
f. [Signature of consumer(s)] (only when this form is submitted on paper)
* Delete what is not applicable or fill in what is applicable.
