Revocation form

Model form for revocation


"Annex 2 of Book VI Code of Economic Law"


(please fill out this form only and return it if you want to revoke the agreement)


To:

Your company address

email : info@test.be

fax : 056

I hereby inform you that I terminate our agreement regarding the sale of the following goods:


Reference order:

Ordered on / Received on (delete what does not apply):

Name consumer:

Address consumer:



Date:

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




We will send you a confirmation of your withdrawal by email. You must return the goods within 14 days of receipt or by collecting them. In this case, the costs of collection (8.41 € VAT incl.) Are deducted from your debts.




e-mail:

bankaccountnr