Model form for cancellation


(only fill in this form and return it when you want to cancel the contract)


- To: [name of entrepreneur]

[geographic address entrepreneur]

[facsimile number entrepreneur, if available]

[e-mail address or electronic address of entrepreneur]


- I / We * share / share * hereby inform you that I / we * are in agreement

the sale of the following products: [product designation] *

the delivery of the following digital content: [indication of digital content] *

the performance of the following service: [service designation] *,

revoke / revoke *


- Ordered on * / received on * [date of ordering with services or receipt of products]


- [Consumer name (s)]


- [Consumer address (s)]


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



* Delete what is not applicable or fill in what is applicable.