CANCELLATION FORM
(This form should only be printed, completed, and returned if you wish to cancel the agreement)

— To: BV SANTUREL,
with registered office at 8980 Zonnebeke, Lange Dreve 8F,
registered in the Belgian Crossroads Bank of Enterprises under number 0461.393.564, VAT number BE 0461.393.564
Tel: +32 495 23 81 76
E-mail: info@santurel.net

— I/We () hereby inform you that I/we () cancel/cancelled () our agreement regarding the purchase of the following goods ()/the provision of the following service (*)

Ordered on: [Order date]

Received on: [Date of receipt]

Name(s) of the Customer(s): [Your name(s)]

Address of the Customer(s): [Your address]

Date: [Current date]

Signature of the Customer(s): ___________________________

(*) Cross out what does not apply.

You can now fill out, print, sign, and return this form to BV SANTUREL using the provided contact details (email or mail).