Revocation form

Revocation form

“Appendix 2 of Book VI Code of Economic Law MODEL FORM FOR REVOCATION (only complete and return this form if you want to revoke the contract)

– To:
exochique bvba
Sint-Medardusstraat 42
B-3700 Tongeren, Belgium


– I herewith inform you that I revoke our agreement concerning the sale of the following good(s):

-Order number:

-Concerned product / products (*):

-Ordered on (*)

-Received on (*)

-Name client:

-Email client:

-Address client:

-Client signature (only when this form is submitted on paper)


(*) Strike out what does not apply. “