Cobaja goldsmith studio
Attn: Returns Department
Schweitzer Street 42
1433 AG Kudelstaart

Date : __ – __ – ____
Location: _______________

Returns Department,

I/We (*) hereby inform(*) you that I/We (*) revoke(*) our contract regarding the sale of the following goods/delivery of the following service (*):

Ordered on : __ – __ _ ____

Order Number : #______

Received on: __ – __ – ____

Name :______________________

Address :______________________

______________________

IBAN account no:

Date:

Signature :