Model withdrawal form

Consumers may use this form to withdraw from an agreement within the statutory cooling-off period. You are not required to use this form; you may also withdraw by another clear statement, for example by email.

Please note: business orders are not covered by the statutory consumer right of withdrawal. Returns may be excluded for certain products, such as opened, contaminated, specially ordered or hazardous goods. See also the Returns.

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Model form

Complete and return this form only if you wish to withdraw from the agreement.

To:
DutchChems
Klokjeslaan 95
3601 HD Maarssen
The Netherlands
Email: [email protected]

I/We (*) hereby give notice that I/we (*) withdraw from my/our (*) agreement for the sale of the following goods/provision of the following service (*):

………………………………………………………………………………………………….

………………………………………………………………………………………………….

Ordered on (*) / received on (*):

………………………………………………………………………………………………….

Name of consumer(s):

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Address of consumer(s):

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Order number, if known:

………………………………………………………………………………………………….

IBAN/bank account number for reimbursement, if required:

………………………………………………………………………………………………….

Signature of consumer(s) (only if this form is submitted on paper):

………………………………………………………………………………………………….

Date:

………………………………………………………………………………………………….

(*) Delete as appropriate.

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Source and use

This form follows the structure of the European model cancellation/withdrawal form used in consumer guidance by the Netherlands Authority for Consumers and Markets. If in doubt, always check the current returns conditions and contact us before returning chemicals or other regulated products.