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- Multicare-Centrum.nl, Pasteurstraat 10, 2811 DX Reeuwijk Netherlands, [email protected], phone number: + 31 182 391 210
- I / we [*] hereby give notice that I / we [*] cancel my / our [*] contract of sale of the following goods [*] / for the supply of the following service [*], - Ordered on [*] / received on [*]
- Name of consumer(s)
- Address of consumer(s)
- Signature of consumer(s) (only if this form is notified on paper)
- Date
[*] Delete as appropriate