Model withdrawal form
(complete and return this form only if you wish to cancel the agreement)

At:
house KOOS
T. Hermansplein 24
5144 ZE Waalwijk

hello@maisonkoos.nl

I/We* hereby inform you that I/we* revoke* our agreement regarding the sale of the following products


Product designation(s):_________________


___________________________________


___________________________________


___________________________________



Ordered on: _________________________


Order number: ______________________


Received on:_______________________