To: The Online Portrait Gallery Paramaribostraat 2 A 2585 GN Den Haag The Netherlands
info@theonlineportraitgallery.com
I / we hereby withdraw from the agreement signed by me/us for the purchase of the following goods/the provision of the following service:
Ordered on:
Received on:
Order number:
Invoice number:
Name:
Address:
Email address:
Signature:
___________________________
Attachment:
