MODEL WITHDRAWAL FORM

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

To: De Haardwinkel
Margrietlaan 70
info@dehaardwinkel.nl

I / We * share / share * hereby inform you that I / we * regarding our agreement

the sale of the following products: ........................................ *

the provision of the following service: ........................................ *,

revoked / revoked *

Ordered on * / received on *: ........................................

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

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

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

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

* Delete what does not apply or fill in what applies.