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Withdrawal Form

Flanders Scientific Europe - Weggevoerdenstraat 128 - 3980 Tessenderlo-Ham - Belgium

BE1029223052 - europeansales@flandersscientific.com

Please note: the right of withdrawal applies exclusively to consumers (B2C). If you are purchasing on behalf of a company or as a professional (B2B), the right of withdrawal does not apply to your order.

I hereby notify you of my withdrawal from the contract for the sale of the following goods:

Description of the goods

Date on which the goods were ordered

Date on which the goods were received

Ordernumber

Name

Street & number

Postal code & City

Country

Email address

Phone number

Date of submission

By submitting this form, I confirm that the information provided above is correct and that I wish to exercise my right of withdrawal.