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)

Beeronweb

Remi  Claeysstraat 96 8210 Zedelgem

email : info@drankencentralerotsaert.be

tel : 050/209498

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