To:
Media Websolutions B.V.
Spikweien 25
5943 AC Lomm
Netherlands
E-Mail: info@mediawebsolutionsbv.com
Hereby I/we revoke the contract entered, regarding the purchase of the following goods/ rendering the following services ______________________________
Ordered on /received on ____________________________
Name of consumer (s) _____________________________
Address of Consumer(s) _______________________________
Signature of Consumer(s) (applies to letter notification only) _________________________
Date ___________________
Delete as applicable.