Return form

Dear Customer, you only need to complete and return this form if you wish to withdraw from the agreement.

To Casa Mimi VOF, Vaartstraat 92 2235 Hulshout,

I/We (*) hereby inform you that I/We (*) revoke (*) our agreement regarding the sale of the following goods/supply of the following service (*):

Ordered on (*)/Received on (*):

Name(s) of consumer(s):

Address consumer(s):

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

Date :

(*) Delete what is not applicable.

Also see