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"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)
Remi Claeysstraat 96 8210 Zedelgem
email : firstname.lastname@example.org
tel : 050/209498
I hereby inform you that I terminate our agreement regarding the sale of the following goods:
Ordered on / Received on (delete what does not apply):
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.