model withdrawal form

Only fill out and return this form if you wish to withdraw from the agreement. The use of this form is not mandatory. You may also inform us of your withdrawal clearly by email.

To:
De Biersalon
Attn: Roel van der Donk
Kreijerstraat 6
6101 CL Echt
The Netherlands
info@debiersalon.nl

I/we hereby give notice that I/we withdraw from my/our contract of sale of the following products:

Product(s):
................................................................................

Order number:
................................................................................

Ordered on:
................................................................................

Received on:
................................................................................

Name of consumer(s):
................................................................................

Address of consumer(s):
................................................................................

Signature of consumer(s), only if this form is submitted on paper:

................................................................................

Date:
................................................................................

Delete as appropriate.