Return Form


D&R Coaching Consulting, Funenpark 501, 1018 AK Amsterdam, mobile: 0613253655


I hereby inform you that I wish to revoke our agreement on the following order: 


Order number:

Ordered/received on (dd-mm-yyyy): 

Fill in the date on which you received your order or the date of your order. 

First name and surname: 

Street name + house number: 

ZIP code: 

Place of domicile: 

Email address:

IBAN number:





Sign this form only if you will not send this form by email.


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