Model withdrawal form

Model form for cancellation / withdrawal

Only fill in and return this form if you wish to cancel / withdraw from the agreement.

To

edwin@moodcompany.nl

Mood Company BV

regarding cancellation/revocation

Malachietdreef 49

7828 CM Emmen

I/We (*) hereby inform you that I/we (*) revoke the agreement regarding the sale of the following goods/provision of the following service (*)

Ordered on:

Received on:

Name(s) of consumer(s):

Address of consumer(s):

Signature of consumer(s) [only when this form is submitted on paper]

Date:

(*) Cross out what does not apply.