Withdrawal form

Please complete and return this form only if you wish to cancel/revoke the agreement.

To Evelien Lanotte, Hoogstraat 20, 9250 Waasmunster, papegaaishop@gmail.com :

I/We hereby give notice that I revoke our agreement concerning the sale of the following goods:

• Ordered on: [date]

• Received on: [date]

• Consumer name:

• Consumer address:

• Consumer signature (paper form only):

• Date: