Revocation form

    To:
    Atlas Old Maps
    Paramaribostraat 2 A
    2585 GN Den Haag
    The Netherlands

    info@atlasoldmaps.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: