Return Form

To: 

D&R Coaching Consulting, Funenpark 501, 1018 AK Amsterdam dorota@careerjump.nl, 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:

Date: 

Signature

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