Cancellation Form

B. Cancellation Form

If you would like to withdraw from the contract, please fill out this form and send it to:

ZanaMed (Eenmanszaak)
Van Hogendorpstraat 127

5046LC Tilburg
Netherlands

Email: sales[at]mentaloptimering.com
Phone: +31 (0) 685 312316 

I/We (*) hereby give notice that I/we (*) withdraw from the contract of sale of the following goods/provision of the following service (*)

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Ordered on (*) ____________________ / Received on (*) ____________________

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Name of Consumer(s)

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Address of Consumer(s)

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Signature of Consumer(s) (only for paper notice)

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Date

(*) Delete as applicable