Withdrawal form

(Only complete and return this form when you want to cancel the agreement. Download here a PDF file)

To:
Dutch Accent
Berenstraat 41
1016 GG, Amsterdam, NL
info@dutch-accent.nl
+31 20 420 21 20

— I / We (*) hereby inform you that I / We (*) revoke our agreement relating to the sale of the following goods / provision of the following service:

 

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— Date of purchase (DD-MM-YYYY) :                           — Ordernumber:

____________________________                           _______________________

— Delivered on (DD-MM-YYYY):

____________________________

— Name/Names consumer(s):

 

______________________________________________________________

— Address consumer(s):

____________________________

____________________________

____________________________

— IBAN Bankaccount number:

____________________________

— Signature of the consumer(s) (only if this form be submitted in paper)

 

______________________________________________________________

— Date (DD-MM-YYYY):

_____________________________

(*) Delete what is not applicable.

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