Model form for dissolution/revocation

Model form for dissolution/withdrawal

Only complete and return this form if you wish to dissolve/revoke the agreement. 

At

info@moodcompany.nl

Mood Company BV

subject to dissolution/revocation

Malachietdreef 49

7828CM Emmen

 

I/We (*) hereby inform you that I/we (*) revoke our agreement concerning the sale of the following goods/provision of the following service (*)

 

Ordered on:

Received on:

 

Name(s) of consumer(s):

Consumer(s) address:

 

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

Date:

 

(*) Cross out what does not apply.