Terms of service

General Terms and Conditions Thuiswinkel

Table of contents:

Article 1 - Definitions

Article 2 - Identity of the entrepreneur

Article 3 - Applicability

Article 4 - The offer

Article 5 - The agreement

Article 6 - Right of withdrawal

Article 7 - Consumer’s obligations during the withdrawal period

Article 8 - Exercising the right of withdrawal by the consumer and costs thereof

Article 9 - Entrepreneur’s obligations in the event of withdrawal

Article 10 - Exclusion of the right of withdrawal

Article 11 - The price

Article 12 - Performance of the agreement and additional guarantee

Article 13 - Delivery and performance

Article 14 - Continuing transactions: term, termination and renewal

Article 15 - Payment

Article 16 - Complaints procedure

Article 17 - Disputes

Article 18 - Industry guarantee

Article 19 - Additional or deviating provisions

Article 20 - Amendment of the General Terms and Conditions Thuiswinkel

Article 1 - Definitions

In these terms and conditions the following definitions apply:

1. Additional agreement: an agreement whereby the consumer acquires products, digital content and/or services in connection with a distance contract and these goods, digital content and/or services are supplied by the entrepreneur or by a third party on the basis of an arrangement between that third party and the entrepreneur;
2. Withdrawal period: the period within which the consumer may exercise the right of withdrawal;
3. Consumer: the natural person who does not act for purposes relating to his/her trade, business, craft or profession;
4. Day: calendar day;
5. Digital content: data produced and supplied in digital form;
6. Continuing agreement: an agreement aimed at the regular supply of goods, services and/or digital content over a certain period of time;
7. Durable medium: any tool — including e-mail — that enables the consumer or entrepreneur to store information addressed personally to him/her in a way that allows future consultation or use for a period appropriate to the purpose for which the information is intended, and which allows unchanged reproduction of the stored information;
8. Right of withdrawal: the possibility for the consumer to withdraw from the distance contract within the withdrawal period;
9. Entrepreneur: the natural or legal person who is a member of Thuiswinkel.org and offers products, (access to) digital content and/or services to consumers at a distance;
10. Distance contract: an agreement concluded between the entrepreneur and the consumer within the framework of an organised system for distance selling of products, digital content and/or services, whereby up to and including the conclusion of the agreement exclusive or joint use is made of one or more techniques for distance communication;
11. Model withdrawal form: the European model withdrawal form included in Annex I to these terms and conditions. Annex I need not be made available if the consumer has no right of withdrawal in respect of his/her order;
12. Technique for distance communication: a means that can be used to conclude an agreement, without consumer and entrepreneur having to be in the same place at the same time.

Article 2 - Identity of the entrepreneur

Entrepreneur name: Grixx B.V.

Trading under the name(s): Grixx

Registered address:
Curieweg 15
2408 BZ Alphen a/d Rijn
The Netherlands

Telephone number: +31172636666

Availability:
Monday through Friday from 08:30 to 17:30

E-mail address: info@grixx.eu

Chamber of Commerce no.: 80600441

VAT number: NL861731268B01

If the entrepreneur’s activity is subject to a relevant licensing regime: the details of the supervisory authority.

If the entrepreneur practises a regulated profession:

• the professional association or organisation to which he/she is affiliated;
• the professional title, the place in the EU or the European Economic Area where it was awarded;
• a reference to the professional rules applicable in the Netherlands and instructions where and how these rules can be accessed.

Article 3 - Applicability

1. These general terms and conditions apply to every offer made by the entrepreneur and to every distance contract concluded between the entrepreneur and the consumer.
2. Before the distance contract is concluded, the text of these general terms and conditions will be made available to the consumer. If this is not reasonably possible, the entrepreneur will, before the distance contract is concluded, indicate how the general terms and conditions can be inspected at the entrepreneur’s premises and that they will be sent to the consumer free of charge as soon as possible upon request.
3. If the distance contract is concluded electronically, the text of these general terms and conditions may, contrary to the previous paragraph and before the distance contract is concluded, be made available to the consumer electronically in such a way that the consumer can easily store it on a durable medium. If this is not reasonably possible, it will be indicated before the distance contract is concluded where the general terms and conditions can be consulted electronically and that they will be sent to the consumer free of charge electronically or otherwise upon request.
4. In the event that specific product or service conditions apply in addition to these general terms and conditions, the second and third paragraphs apply accordingly, and in case of conflicting conditions the consumer may always rely on the applicable provision that is most favourable to him/her.

Article 4 - The offer

1. If an offer has a limited period of validity or is subject to conditions, this will be explicitly stated in the offer.
2. The offer contains a complete and accurate description of the products, digital content and/or services offered. The description is sufficiently detailed to enable the consumer to properly assess the offer. If the entrepreneur uses images, these are a truthful representation of the products, services and/or digital content offered. Obvious mistakes or errors in the offer do not bind the entrepreneur.
3. Each offer contains such information that it is clear to the consumer what rights and obligations are attached to acceptance of the offer.

Article 5 - The agreement

1. The agreement is concluded, subject to the provisions of paragraph 4, at the moment the consumer accepts the offer and meets the conditions set.
2. If the consumer has accepted the offer electronically, the entrepreneur will promptly confirm receipt of acceptance electronically. As long as receipt of this acceptance has not been confirmed by the entrepreneur, the consumer may dissolve the agreement.
3. If the agreement is concluded electronically, the entrepreneur will take appropriate technical and organisational measures to secure the electronic transfer of data and will ensure a safe web environment. If the consumer can pay electronically, the entrepreneur will observe appropriate security measures.
4. The entrepreneur may, within legal frameworks, obtain information on whether the consumer can meet his/her payment obligations, as well as all facts and factors relevant to responsibly entering into the distance contract. If the entrepreneur has good grounds based on this investigation not to enter into the agreement, he is entitled to refuse an order or request with reasons or to attach special conditions to its performance.
5. The entrepreneur will provide the consumer, at the latest upon delivery of the product, service or digital content, the following information in writing or in such a way that the consumer can store it in an accessible manner on a durable medium:
   1. the visiting address of the entrepreneur’s establishment where the consumer can submit complaints;
   2. the conditions under which and the manner in which the consumer can exercise the right of withdrawal, or a clear statement regarding the exclusion of the right of withdrawal;
   3. information on guarantees and existing after-sales service;
   4. the price including all taxes of the product, service or digital content; where applicable the costs of delivery; and the method of payment, delivery or performance of the distance contract;
   5. the requirements for termination of the agreement if the agreement has a duration of more than one year or is of indefinite duration;
   6. if the consumer has a right of withdrawal, the model withdrawal form.
6. In the case of a continuing transaction, the provision in the previous paragraph applies only to the first delivery.

Article 6 - Right of withdrawal

For products:

1. The consumer may dissolve an agreement regarding the purchase of a product during a withdrawal period of at least 14 days without giving reasons. The entrepreneur may ask the consumer for the reason for withdrawal, but may not oblige the consumer to state his/her reason(s).
2. The withdrawal period referred to in paragraph 1 starts on the day after the consumer, or a third party designated by the consumer in advance who is not the carrier, has received the product, or:
   1. if the consumer has ordered multiple products in one order: the day on which the consumer, or a third party designated by him/her, has received the last product. The entrepreneur may refuse an order of multiple products with different delivery times, provided he informed the consumer clearly about this prior to the ordering process.
   2. if delivery of a product consists of several shipments or parts: the day on which the consumer, or a third party designated by him/her, has received the last shipment or the last part;

1. in the case of agreements for regular delivery of products over a certain period: the day on which the consumer, or a third party designated by him/her, has received the first product.

For services and digital content not supplied on a tangible medium:

1. The consumer may dissolve a service agreement and an agreement for the supply of digital content not supplied on a tangible medium during a withdrawal period of at least 14 days without giving reasons. The entrepreneur may ask the consumer for the reason for withdrawal, but may not oblige the consumer to state his/her reason(s).
2. The withdrawal period referred to in paragraph 3 starts on the day following the conclusion of the agreement.

Extended withdrawal period for products, services and digital content not supplied on a tangible medium in the absence of information on the right of withdrawal:

1. If the entrepreneur has not provided the consumer with the legally required information on the right of withdrawal or the model withdrawal form, the withdrawal period expires twelve months after the end of the original withdrawal period determined in accordance with the previous paragraphs of this article.
2. If the entrepreneur provided the information referred to in the previous paragraph to the consumer within twelve months after the start date of the original withdrawal period, the withdrawal period expires 14 days after the day on which the consumer received that information.

Article 7 - Consumer’s obligations during the withdrawal period

1. During the withdrawal period the consumer will handle the product and the packaging with care. He/she will only unpack or use the product to the extent necessary to establish the nature, characteristics and functioning of the product. The guiding principle is that the consumer may only handle and inspect the product as he/she would be allowed to do in a shop.
2. The consumer is only liable for any diminished value of the product resulting from handling the product beyond what is permitted in paragraph 1.
3. The consumer is not liable for diminished value of the product if the entrepreneur did not provide him/her with all legally required information on the right of withdrawal before or at the conclusion of the agreement.

Article 8 - Exercising the right of withdrawal by the consumer and costs thereof

1. If the consumer exercises his/her right of withdrawal, he/she will notify the entrepreneur within the withdrawal period by means of the model withdrawal form or in another unambiguous manner.
2. As soon as possible, but within 14 days from the day following the notification referred to in paragraph 1, the consumer will return the product or hand it over to (an authorised representative of) the entrepreneur. This is not necessary if the entrepreneur has offered to collect the product himself. The consumer has observed the return period in any event if he/she returns the product before the withdrawal period has expired.
3. The consumer returns the product with all delivered accessories, if reasonably possible in its original condition and packaging, and in accordance with the reasonable and clear instructions provided by the entrepreneur.
4. The risk and the burden of proof for the correct and timely exercise of the right of withdrawal lie with the consumer.
5. The consumer bears the direct costs of returning the product. If the entrepreneur has not stated that the consumer must bear these costs or if the entrepreneur indicates that he will bear the costs himself, the consumer does not have to bear the costs of return.
6. If the consumer withdraws after having expressly requested that the performance of the service or the supply of gas, water or electricity that is not put up for sale in a limited volume or set quantity begins during the withdrawal period, the consumer owes the entrepreneur an amount that is proportional to that part of the obligation that has been performed by the entrepreneur at the time of withdrawal, compared with full performance of the obligation.
7. The consumer does not bear any costs for the performance of services or the supply of water, gas or electricity that is not put up for sale in a limited volume or quantity, or for the supply of district heating, if:
   1. the entrepreneur has not provided the consumer with the legally required information on the right of withdrawal, the cost compensation in the event of withdrawal, or the model withdrawal form; or
   2. the consumer did not expressly request the start of the performance of the service or the supply of gas, water, electricity or district heating during the withdrawal period.
8. The consumer does not bear any costs for the full or partial delivery of digital content not supplied on a tangible medium if:
   1. prior to delivery, he/she did not expressly consent to commencing performance of the agreement before the end of the withdrawal period;
   2. he/she did not acknowledge losing the right of withdrawal when giving consent; or
   3. the entrepreneur failed to confirm this statement by the consumer.
9. If the consumer exercises his/her right of withdrawal, all additional agreements are dissolved by operation of law.

Article 9 - Entrepreneur’s obligations in the event of withdrawal

1. If the entrepreneur enables the consumer to notify withdrawal electronically, he will send an acknowledgement of receipt without delay after receiving this notification.
2. The entrepreneur will reimburse all payments made by the consumer, including any delivery costs charged by the entrepreneur for the returned product, without delay but within 14 days following the day on which the consumer notifies him of the withdrawal. Unless the entrepreneur offers to collect the product himself, he may wait with reimbursement until he has received the product or until the consumer has demonstrated that he has returned the product, whichever occurs first.
3. The entrepreneur will use the same means of payment as used by the consumer for reimbursement, unless the consumer agrees to a different method. The reimbursement is free of charge for the consumer.
4. If the consumer has chosen a more expensive method of delivery than the cheapest standard delivery, the entrepreneur does not have to reimburse the additional costs for the more expensive method.

Article 10 - Exclusion of the right of withdrawal

The entrepreneur may exclude the following products and services from the right of withdrawal, but only if the entrepreneur clearly stated this in the offer, or at least in good time before concluding the agreement:

1. Products or services whose price is subject to fluctuations in the financial market over which the entrepreneur has no influence and which may occur within the withdrawal period.
2. Agreements concluded during a public auction. A public auction means a method of sale whereby products, digital content and/or services are offered by the entrepreneur to the consumer who is personally present or is given the possibility to be personally present at the auction, under the direction of an auctioneer, and whereby the successful bidder is obliged to purchase the products, digital content and/or services;
3. Service agreements, after full performance of the service, but only if:
   1. performance has begun with the consumer’s express prior consent; and
   2. the consumer has declared that he/she loses the right of withdrawal once the entrepreneur has fully performed the agreement;
4. Package travel as referred to in Section 7:500 of the Dutch Civil Code (BW) and passenger transport agreements;
5. Service agreements for the provision of accommodation, if the agreement provides for a specific date or period of performance and other than for residential purposes, goods transport, car rental services and catering;
6. Agreements relating to leisure activities, if the agreement provides for a specific date or period of performance;
7. Products manufactured to the consumer’s specifications, which are not prefabricated and are produced on the basis of an individual choice or decision by the consumer, or which are clearly intended for a specific person;
8. Products that spoil quickly or have a limited shelf life;
9. Sealed products which are not suitable for return for reasons of health protection or hygiene and whose seal has been broken after delivery;
10. Products which, after delivery, are by their nature irrevocably mixed with other products;
11. Alcoholic beverages, the price of which is agreed upon at the conclusion of the agreement, but delivery of which can only take place after 30 days, and the actual value of which depends on market fluctuations over which the entrepreneur has no influence;
12. Sealed audio and video recordings and computer software, the seal of which has been broken after delivery;
13. Newspapers, periodicals or magazines, with the exception of subscriptions thereto;
14. The supply of digital content other than on a tangible medium, but only if:
    1. performance has begun with the consumer’s express prior consent; and
    2. the consumer has declared that he/she thereby loses the right of withdrawal.

Article 11 - The price

1. During the period of validity stated in the offer, the prices of the products and/or services offered will not be increased, except for price changes due to changes in VAT rates.
2. Contrary to the previous paragraph, the entrepreneur may offer products or services whose prices are subject to fluctuations in the financial market over which the entrepreneur has no influence, at variable prices. This dependence on fluctuations and the fact that any stated prices are target prices will be stated in the offer.
3. Price increases within 3 months after the conclusion of the agreement are only permitted if they are the result of statutory regulations or provisions.
4. Price increases from 3 months after the conclusion of the agreement are only permitted if the entrepreneur has stipulated this and:
   1. they are the result of statutory regulations or provisions; or
   2. the consumer is authorised to terminate the agreement with effect from the day on which the price increase takes effect.
5. The prices stated in the offer of products or services include VAT.

Article 12 - Performance of the agreement and additional guarantee

1. The entrepreneur guarantees that the products and/or services comply with the agreement, the specifications stated in the offer, the reasonable requirements of soundness and/or usability, and the statutory provisions and/or government regulations in force on the date the agreement is concluded. If agreed, the entrepreneur also guarantees that the product is suitable for other than normal use.
2. An additional guarantee provided by the entrepreneur, his supplier, manufacturer or importer never limits the statutory rights and claims that the consumer can assert against the entrepreneur under the agreement if the entrepreneur has failed to perform his part of the agreement.
3. An additional guarantee means any undertaking by the entrepreneur, his supplier, importer or producer whereby he grants the consumer certain rights or claims that go beyond what he is legally obliged to do if he has failed to perform his part of the agreement.

Article 13 - Delivery and performance

1. The entrepreneur will exercise the greatest possible care when receiving and fulfilling orders for products and when assessing requests for services.
2. The place of delivery is the address made known by the consumer to the entrepreneur.
3. With due observance of what is stated about this in Article 4 of these general terms and conditions, the entrepreneur will execute accepted orders with due speed but no later than within 30 days, unless a different delivery period has been agreed. If delivery is delayed, or if an order cannot be executed or can only be executed partially, the consumer will receive notice of this no later than 30 days after placing the order. In such a case, the consumer is entitled to dissolve the agreement without costs and is entitled to any compensation.
4. After dissolution in accordance with the previous paragraph, the entrepreneur will promptly refund the amount paid by the consumer.
5. The risk of damage and/or loss of products rests with the entrepreneur until the moment of delivery to the consumer or a representative designated in advance and made known to the entrepreneur, unless expressly agreed otherwise.

Article 14 - Continuing transactions: term, termination and renewal

Termination:

1. The consumer may terminate an agreement entered into for an indefinite period and which extends to the regular delivery of products (including electricity) or services at any time, subject to agreed termination rules and a notice period of no more than one month.
2. The consumer may terminate an agreement entered into for a fixed period and which extends to the regular delivery of products (including electricity) or services at any time at the end of the fixed term, subject to agreed termination rules and a notice period of no more than one month.
3. The consumer may terminate the agreements referred to in the previous paragraphs:
   • at any time and not be restricted to termination at a specific time or during a specific period;
   • at least in the same manner as they were entered into by the consumer;
   • always with the same notice period as the entrepreneur has stipulated for himself.

Renewal:

1. An agreement entered into for a fixed period and which extends to the regular delivery of products (including electricity) or services may not be tacitly renewed or extended for a fixed period.
2. Contrary to the previous paragraph, an agreement entered into for a fixed period and which extends to the regular delivery of daily, news and weekly newspapers and magazines may be tacitly renewed for a fixed period of up to three months, if the consumer may terminate this renewed agreement at the end of the renewal with a notice period of no more than one month.
3. An agreement entered into for a fixed period and which extends to the regular delivery of products or services may only be tacitly renewed for an indefinite period if the consumer may terminate it at any time with a notice period of no more than one month. The notice period is no more than three months if the agreement extends to the regular, but less than once a month, delivery of daily, news and weekly newspapers and magazines.
4. An agreement of limited duration for the regular delivery of daily, news and weekly newspapers and magazines for introductory purposes (trial or introductory subscription) is not tacitly continued and ends automatically after the trial or introductory period has ended.

Term:

1. If an agreement has a term of more than one year, the consumer may terminate the agreement at any time after one year with a notice period of no more than one month, unless reasonableness and fairness oppose termination before the end of the agreed term.

Article 15 - Payment

1. Unless otherwise stipulated in the agreement or additional terms and conditions, amounts owed by the consumer must be paid within 14 days after the start of the withdrawal period, or, if there is no withdrawal period, within 14 days after the conclusion of the agreement. In the case of an agreement to provide a service, this period starts on the day after the consumer has received confirmation of the agreement.
2. In the sale of products to consumers, the consumer may never be obliged in general terms and conditions to make an advance payment of more than 50%. Where advance payment has been stipulated, the consumer cannot assert any right regarding execution of the order or service(s) concerned before the stipulated advance payment has been made.
3. The consumer has the duty to promptly report inaccuracies in provided or stated payment details to the entrepreneur.
4. If the consumer does not meet his payment obligation(s) in time, he is, after having been informed by the entrepreneur of the late payment and after the entrepreneur has granted the consumer a period of 14 days, starting on the day after receipt of the reminder, to still meet his payment obligations, and if payment is not made within this 14-day period, liable for statutory interest on the outstanding amount and the entrepreneur is entitled to charge the extrajudicial collection costs incurred. These collection costs amount to a maximum of: 15% on outstanding amounts up to €2,500; 10% on the next €2,500; and 5% on the next €5,000, with a minimum of €40. The entrepreneur may deviate from the stated amounts and percentages to the benefit of the consumer.

Article 16 - Complaints procedure

1. The entrepreneur has a sufficiently publicised complaints procedure and handles complaints in accordance with this complaints procedure.
2. Complaints about performance of the agreement must be submitted to the entrepreneur within a reasonable time after the consumer has discovered the defects, fully and clearly described.
3. Complaints submitted to the entrepreneur will be answered within a period of 14 days from the date of receipt. If a complaint requires a foreseeably longer processing time, the entrepreneur will respond within the 14-day period with an acknowledgement of receipt and an indication of when the consumer can expect a more detailed response.
4. A complaint about a product, service or the entrepreneur’s service can also be submitted via a complaint form on the consumer page of the Thuiswinkel.org website www.thuiswinkel.org. The complaint will then be sent both to the relevant entrepreneur and to Thuiswinkel.org.
5. The consumer must give the entrepreneur at least 4 weeks to resolve the complaint by mutual consultation. After this period, a dispute arises that is eligible for the dispute resolution procedure.

Article 17 - Disputes

1. Dutch law applies exclusively to agreements between the entrepreneur and the consumer to which these general terms and conditions relate. If the entrepreneur directs his activities to the country where the consumer resides, the consumer may also always rely on the mandatory consumer law of his country.
2. Disputes between the consumer and the entrepreneur regarding the formation or performance of agreements relating to products and services to be supplied or supplied by this entrepreneur may, with due observance of the provisions below, be submitted by both the consumer and the entrepreneur to the Thuiswinkel Disputes Committee (Geschillencommissie Thuiswinkel), P.O. Box 90600, 2509 LP The Hague, The Netherlands (www.sgc.nl).
3. A dispute will only be handled by the Disputes Committee if the consumer has first submitted his complaint to the entrepreneur within a reasonable time.
4. If the complaint does not lead to a solution, the dispute must be submitted to the Disputes Committee in writing or in another form to be determined by the Committee no later than 12 months after the date on which the consumer submitted the complaint to the entrepreneur.
5. If the consumer wishes to submit a dispute to the Disputes Committee, the entrepreneur is bound by this choice. Preferably, the consumer informs the entrepreneur of this first.
6. If the entrepreneur wishes to submit a dispute to the Disputes Committee, the consumer must state in writing within five weeks after a written request by the entrepreneur whether he also wishes this or whether he wants the dispute to be handled by the competent court. If the entrepreneur does not receive the consumer’s choice within the period of five weeks, the entrepreneur is entitled to submit the dispute to the competent court.
7. The Disputes Committee issues decisions under the conditions as set out in the regulations of the Disputes Committee (www.degeschillencommissie.nl/over-ons/de-commissies/2404/thuiswinkel). The decisions of the Disputes Committee are binding advice.
8. The Disputes Committee will not handle a dispute or will discontinue handling if the entrepreneur has been granted suspension of payment, has been declared bankrupt or has effectively ceased business activities, before the Committee has heard the dispute at a hearing and issued a final decision.
9. If, in addition to the Thuiswinkel Disputes Committee, another recognised disputes committee affiliated with the Stichting Geschillencommissies voor Consumentenzaken (SGC) or the Financial Services Complaints Institute (Kifid) is competent, then for disputes mainly concerning the method of distance selling or services, the Thuiswinkel Disputes Committee is preferably competent. For all other disputes, the other recognised disputes committee affiliated with SGC or Kifid is competent.

Article 18 - Industry guarantee

1. Thuiswinkel.org guarantees compliance by its members with the binding advice of the Thuiswinkel Disputes Committee, unless the member decides to submit the binding advice to the court for review within two months after it has been sent. This guarantee is revived if the binding advice has been upheld after judicial review and the judgment evidencing this has become final. Up to a maximum amount of €10,000 per binding advice, this amount will be paid out by Thuiswinkel.org to the consumer. For amounts higher than €10,000 per binding advice, €10,000 will be paid out. For the remainder, Thuiswinkel.org has a best-efforts obligation to ensure that the member complies with the binding advice.
2. Application of this guarantee requires that the consumer makes a written appeal to Thuiswinkel.org and that he transfers his claim against the entrepreneur to Thuiswinkel.org. If the claim against the entrepreneur exceeds €10,000, the consumer will be offered to transfer his claim insofar as it exceeds €10,000 to Thuiswinkel.org, after which this organisation will, in its own name and at its own expense, claim payment thereof in court for satisfaction to the consumer.

Article 19 - Additional or deviating provisions

Additional provisions or provisions deviating from these general terms and conditions may not be to the detriment of the consumer and must be recorded in writing or in such a way that they can be stored by the consumer in an accessible manner on a durable medium.

Article 20 - Amendment of the General Terms and Conditions Thuiswinkel

1. Amendments to these terms and conditions are only effective after they have been published in an appropriate manner, with the understanding that in the case of applicable amendments during the term of an offer, the provision most favourable to the consumer shall prevail.

Thuiswinkel.org

www.thuiswinkel.org

Horaplantsoen 20, 6717 LT Ede

P.O. Box 7001, 6710 CB Ede

Annex I: Model withdrawal form

Model withdrawal form

(complete and return this form only if you wish to withdraw from the agreement)

• To: [name of entrepreneur]

[geographical address of entrepreneur]

[fax number of entrepreneur, if available]

[e-mail address or electronic address of entrepreneur]

• I/We* hereby notify you that I/We* withdraw from my/our* agreement concerning

the sale of the following products: [product description]*

the supply of the following digital content: [digital content description]*

the provision of the following service: [service description]*,

withdraw/withdraw*

• Ordered on*/received on* [date of order for services or receipt for products]
• [Name of consumer(s)]
• [Address of consumer(s)]
• [Signature of consumer(s)] (only if this form is submitted on paper)
• [Date]

* Delete as appropriate or fill in as applicable.