Form dissolution / revocation

Form for dissolution / revocation
Only complete this form and return it if you want to cancel / revoke the agreement.

To: Belleza Fashion Boutique (hereinafter referred to as "Belleza"), Voorstraat 5, 3512 AH, Utrecht

I / We (*) share / share (*) hereby inform you that I / we (*) revoke / revoke our agreement regarding the sale of the following goods / delivery of the next service (*) (*)

  • Reason return:

  • Order number (s):

  • Ordered on (*) / Received on (*):

  • Name / names consumer (s):

  • Address consumer (s):


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

Date

(*) Strike out what does not apply.

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