D&R Coaching Consulting, Funenpark 501, 1018 AK Amsterdam email@example.com, mobile: 0613253655
I hereby inform you that I wish to revoke our agreement on the following order:
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:
Place of domicile:
Sign this form only if you will not send this form by email.