Model Withdrawal Form

 

Please only send this document signed to Percolenti if you 'd prefer to withdraw from the agreement

 

To: Percolenti

Laan van Waalhaven 139A,

A486, 2497 GK Den Haag

E info@percolenti.com

 

I hereby inform you that I revoke our agreement regarding the sale of the following products:

 

Ordered on [date of product receipt]

 

[Consumer's name]

 

[Consumer's address]

 

[Bank account number]

 

[Consumer's signature] (only if this form is submitted on paper)

Cross out what is not applicable or fill in what is applicable.

 

P.S. 1. The withdrawal period for the right of withdrawal is a maximum of 14 days after receiving the goods. If you wish to exercise this right, please inform us first via info@percolenti.com and promptly return the goods along with this fully completed and signed form. The costs of returning the goods are entirely at your expense. Upon receiving the goods in good condition, we will reimburse you the purchase price and any delivery charges incurred by you promptly and in the manner you specify.