Model form for cancellation / withdrawal

Only fill in and return this form if you wish to cancel / withdraw from the agreement.

To *

Foundation Young Dogs

c/o Student Company (*)

Address of student company (*)

Postcode + Place of residence of student company (*)

I hereby inform you, the student company as mentioned above, that I/we wish to withdraw from our agreement regarding the sale of the products listed below

o ______________________________________________

o ______________________________________________

o ______________________________________________

Ordered on_______________ andReceived on ________________

Your name (name of consumer)

__________________________

Your Address (address of consumer)

__________________________

__________________________

Your Bank Account Number (Bank account number of consumer) for crediting the purchase amount

NL ___ ______ __________________

Bank account in the name of: _________________

Date Signature of consumer(s)

[only when this form is submitted on paper]

__________                             _______________________________

(*) The address of the relevant student company is in the order confirmation that was sent with the ordered item