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.