Only complete and return this form if you wish to withdraw from the contract.

To *
Stichting Jonge Honden
Attn: Student Company ()
Address of the student company ()
Postal code and city of the student company (*)

I hereby inform you, the student company mentioned above, that I withdraw from our agreement regarding the sale of the following products:

o ______________________________________________
o ______________________________________________
o ______________________________________________

Ordered on _______________ and received on _______________

Your name (consumer name)

Your address (consumer address)

Your bank account number (consumer bank account number) for refund of the purchase amount

NL ___ ______ ________________

Bank account holder name: ___________________

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

(*) The address of the relevant student company can be found in the order confirmation sent with the ordered product.