Return model form

Model form for returning

Only complete and return this form if you wish to cancel the agreement and have notified us by e-mail.  Please email us the track and trace code.

— To
Precious Stones
Gerrit rietveldsingel 353
1112ZB Diemen
info@precious-stones-byilona.nl
 

—I / We (*)  share  (*) hereby inform you that I / we (*) our agreement regarding the sale of the following goods / provision of the following service (*) revoke: 

 

— Ordered on (DD-MM-YYYY) :                   
 

                                                                           

— Order number :

 

 

— Received on (DD-MM-YYYY):

 

 

— Name (s)  consumer (s): 

 

 

— Address consumer (s): 

 

 

— IBAN bank account:

 

 

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

 

 

— Date (DD-MM-YYYY):

 

 

 

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