Model withdrawal form

To:
Webshop de Roos
Tolstraat 15
5301 AX Zaltbommel, Netherlands
webshopderoos@gmail.com

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods/for the provision of the following service (*)

• Ordered on (*)/received on (*): _______________________________
• Name of consumer(s): _______________________________
• Address of consumer(s): _______________________________
• Order number: _______________________________
• Signature of consumer(s) (only for paper forms): _______________________________
• Date: _______________________________

(*) Delete as appropriate.

You can also use our online withdrawal function.