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Terms and Conditions

Below you will find our general terms and conditions.

General Terms and Conditions of Thuiswinkel

These General Terms and Conditions of the Dutch Thuiswinkel Organization (hereinafter: Thuiswinkel.org) have been established in consultation with the Consumers' Association in the context of the Coordination Group Self-Regulation Consultation (CZ) of the Social and Economic Council and take effect on June 1, 2014.

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 - Obligations of the consumer during the reflection period
  • Article 8 - Exercise of the right of withdrawal by the consumer and costs thereof
  • Article 9 - Obligations of the entrepreneur in case of withdrawal
  • Article 10 - Exclusion of the right of withdrawal
  • Article 11 - The price
  • Article 12 - Performance and extra guarantee
  • Article 13 - Delivery and execution
  • Article 14 - Duration transactions: duration, termination, and extension
  • Article 15 - Payment
  • Article 16 - Complaints procedure
  • Article 17 - Disputes
  • Article 18 - Industry guarantee
  • Article 19 - Additional or different 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 where the consumer acquires products, digital content, and/or services in connection with a distance agreement, and these items, digital content, and/or services are supplied by the entrepreneur or by a third party based on an agreement between that third party and the entrepreneur;
  2. Reflection period: the period within which the consumer can make use of their right of withdrawal;
  3. Consumer: the natural person who does not act for purposes related to their trade, business, craft, or professional activity;
  4. Day: calendar day;
  5. Digital content: data produced and delivered in digital form;
  6. Duration agreement: an agreement that extends to the regular delivery of goods, services, and/or digital content over a certain period;
  7. Durable medium: any tool - including email - that allows the consumer or entrepreneur to store information addressed to them personally in a way that makes future consultation or use possible for a period that is tailored to the purpose for which the information is intended, and that allows unchanged reproduction of the stored information;
  8. Right of withdrawal: the consumer's option to waive the distance agreement within the reflection 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 agreement: an agreement that is concluded between the entrepreneur and the consumer within the framework of an organized system for distance selling of products, digital content, and/or services, whereby exclusive or joint use is made up to and including the conclusion of the agreement of one or more techniques for distance communication;
  11. Model withdrawal form: the European model withdrawal form included in Annex I of these conditions; Annex I does not have to be made available if the consumer does not have a right of withdrawal concerning their order;
  12. Technology for distance communication: means that can be used to conclude an agreement, without the consumer and entrepreneur having to be in the same space simultaneously.

Article 2 - Identity of the Entrepreneur

Name of entrepreneur: Bushcraft.shop BV

Operating under the name/names:
bushcraftshop.nl, bushcraftshop.be, Bushcraft.shop BV

Registered address:
Bushcraft.shop BV
Staverenstraat 15
7418 CJ Deventer
Netherlands

Phone number: +31118436241
Availability: Monday to Sunday from 00:00 to 23:30

Email address: [email protected]

Chamber of Commerce number: 69203873
VAT number: NL857781625B01


Article 3 - Applicability

  1. These general terms and conditions apply to every offer from the entrepreneur and to every distance agreement concluded between the entrepreneur and the consumer.
  2. Before the distance agreement 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 indicate, before the distance agreement is concluded, how the general terms and conditions can be viewed at the entrepreneur's premises and that they will be sent free of charge as soon as possible at the consumer's request.
  3. If the distance agreement is concluded electronically, contrary to the previous paragraph, and before the distance agreement is concluded, the text of these general terms and conditions can be made available to the consumer electronically in such a way that the consumer can easily store them on a durable medium. If this is not reasonably possible, before the distance agreement is concluded, it will be indicated where the general terms and conditions can be viewed electronically and that they will be sent free of charge at the consumer's request either electronically or otherwise.
  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 mutatis mutandis, and the consumer can always invoke the applicable provision that is most favorable to them in the event of conflicting conditions.

Article 4 - The Offer

  1. If an offer has a limited validity period or is subject to conditions, this will be explicitly stated in the offer.
  2. The offer contains a complete and accurate description of the offered products, digital content, and/or services. The description is sufficiently detailed to allow the consumer to make a proper assessment of the offer. If the entrepreneur uses images, they are a true representation of the offered products, services, and/or digital content. Obvious mistakes or obvious errors in the offer are not binding for the entrepreneur.
  3. Each offer contains such information that it is clear to the consumer what rights and obligations are attached to the acceptance of the offer.

Article 5 - The Agreement

  1. The agreement is concluded, subject to the provisions in paragraph 4, at the moment of acceptance by the consumer of the offer and the fulfillment of the conditions set therein.
  2. If the consumer has accepted the offer electronically, the entrepreneur will immediately confirm electronically the receipt of the acceptance of the offer. As long as the receipt of this acceptance has not been confirmed by the entrepreneur, the consumer can dissolve the agreement.
  3. If the agreement is concluded electronically, the entrepreneur will take appropriate technical and organizational measures to secure the electronic transfer of data and will ensure a secure web environment. If the consumer can pay electronically, the entrepreneur will take appropriate security measures.
  4. The entrepreneur can - within the law - inform themselves whether the consumer can meet their payment obligations, as well as all those facts and factors that are important for a responsible conclusion of the distance agreement. If the entrepreneur, based on this investigation, has good reasons not to enter into the agreement, they are entitled to refuse an order or request, or to attach special conditions to the execution.
  5. The entrepreneur will, at the latest upon delivery of the product, service, or digital content to the consumer, send the following information in writing or in such a way that the consumer can store it in an accessible manner on a durable medium:    a. the visit address of the establishment of the entrepreneur where the consumer can go with complaints;    b. the conditions under which and the manner in which the consumer can make use of the right of withdrawal, or a clear statement regarding the exclusion of the right of withdrawal;    c. the information about guarantees and existing service after purchase;    d. 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 execution of the distance agreement;    e. the requirements for terminating the agreement if the agreement has a duration of more than one year or is of indefinite duration;    f. if the consumer has a right of withdrawal, the model withdrawal form.

Article 6 – Right of Withdrawal

For Products:

  1. The consumer can dissolve an agreement related to the purchase of a product during a reflection period of 60 days without giving any reason. The entrepreneur may ask the consumer for the reason for withdrawal but cannot oblige them to state their reason(s).
  2. The reflection period mentioned in paragraph 1 starts on the day after the consumer, or a third party designated by the consumer who is not the carrier, has received the product, or:    a. if the consumer has ordered several products in the same order: the day on which the consumer, or a third party designated by them, has received the last product. The entrepreneur may, provided they have clearly informed the consumer prior to the ordering process, refuse an order for several products with different delivery times.    b. if the delivery of a product consists of several shipments or parts: the day on which the consumer, or a third party designated by them, has received the last shipment or the last part;    c. for agreements for regular delivery of products during a certain period: the day on which the consumer, or a third party designated by them, has received the first product.

For Services and Digital Content Not Delivered on a Tangible Medium:

  1. The consumer can dissolve a service agreement and an agreement for the delivery of digital content not delivered on a tangible medium during 60 days without giving any reason. The entrepreneur may ask the consumer for the reason for withdrawal but cannot oblige them to state their reason(s).
  2. The reflection period mentioned in paragraph 3 starts on the day following the conclusion of the agreement.

Extended Reflection Period for Products, Services, and Digital Content Not Delivered on a Tangible Medium in Case of Non-Information about the Right of Withdrawal:

  1. If the entrepreneur has not provided the consumer with the legally required information about the right of withdrawal or the model withdrawal form, the reflection period ends twelve months after the end of the original reflection period determined in accordance with the previous paragraphs of this article.
  2. If the entrepreneur has provided the information referred to in the previous paragraph to the consumer within twelve months after the effective date of the original reflection period, the reflection period expires 60 days after the day on which the consumer has received that information.

Article 7 - Obligations of the Consumer During the Reflection Period

  1. During the reflection period, the consumer will handle the product and packaging with care. They will only unpack or use the product to the extent necessary to determine the nature, characteristics, and functioning of the product. The guiding principle is that the consumer may only handle and inspect the product as they would be allowed to do in a shop.
  2. The consumer is only liable for depreciation of the product resulting from handling the product in a way that goes beyond what is permitted in paragraph 1.
  3. The consumer is not liable for depreciation of the product if the entrepreneur has not provided them with all legally required information about the right of withdrawal before or at the conclusion of the agreement.

Article 8 - Exercise of the Right of Withdrawal by the Consumer and Costs Thereof

  1. If the consumer makes use of their right of withdrawal, they must report this within the reflection period by means of the model withdrawal form or in another unambiguous manner to the entrepreneur.
  2. As soon as possible, but within 14 days from the day following the notification referred to in paragraph 1, the consumer returns the product, or hands it over to (a representative of) the entrepreneur. This is not necessary if the entrepreneur has offered to collect the product themselves. The consumer has observed the return period in any case if they return the product before the reflection period has expired.
  3. The consumer returns the product with all delivered accessories, if reasonably possible in the original condition and packaging, and in accordance with the reasonable and clear instructions provided by the entrepreneur.
  4. The risk and burden of proof for the correct and timely exercise of the right of withdrawal lies with the consumer.
  5. The consumer bears the direct costs of returning the product. If the entrepreneur has not stated that the consumer has to bear these costs or if the entrepreneur indicates that they will bear the costs themselves, the consumer does not have to bear the costs for returning the product.
  6. If the consumer withdraws after first having explicitly requested that the provision of the service or the supply of gas, water, or electricity not ready for sale be commenced in a limited volume or quantity during the reflection period, the consumer owes the entrepreneur an amount proportional to that part of the obligation that has been fulfilled by the entrepreneur at the time of withdrawal, compared to the full performance of the obligation.
  7. The consumer bears no costs for the execution of services or the supply of water, gas, or electricity, not ready for sale in a limited volume or quantity, or for the supply of district heating if:    a. the entrepreneur has not provided the consumer with the legally required information about the right of withdrawal, the reimbursement of costs upon withdrawal, or the model withdrawal form; or    b. the consumer has not explicitly requested the commencement of the execution of the service or supply of gas, water, electricity, or district heating during the reflection period.
  8. The consumer bears no costs for the full or partial delivery of digital content not delivered on a tangible medium if:    a. they did not explicitly agree to the commencement of the fulfillment of the agreement before the end of the reflection period prior to its delivery;    b. they did not acknowledge losing their right of withdrawal upon giving consent; or    c. the entrepreneur has failed to confirm this statement from the consumer.
  9. If the consumer makes use of their right of withdrawal, all additional agreements will be dissolved by operation of law.

Article 9 - Obligations of the Entrepreneur in Case of Withdrawal

  1. If the entrepreneur makes the notification of withdrawal by the consumer possible electronically, they will send an acknowledgment of receipt immediately after receipt of this notification.
  2. The entrepreneur reimburses all payments from 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 them of the withdrawal. Unless the entrepreneur offers to collect the product themselves, they may wait with reimbursement until they have received the product or until the consumer demonstrates that they have returned the product, whichever comes first.
  3. The entrepreneur uses the same payment method for reimbursement that the consumer used, unless the consumer agrees to another 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 can exclude the following products and services from the right of withdrawal, but only if the entrepreneur has clearly stated this in the offer, or at least in time for the conclusion of 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 is understood to mean a sales method whereby products, digital content, and/or services are offered by the entrepreneur to the consumer who is personally present or has the possibility of being 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 execution of the service, but only if:    a. the execution has started with the explicit prior consent of the consumer; and    b. the consumer has declared that they lose their right of withdrawal once the entrepreneur has fully executed the agreement;
  4. Package holidays as referred to in Article 7:500 BW and agreements of passenger transport;
  5. Service agreements for the provision of accommodation, if the agreement provides for a specific date or period of execution and other than for residential purposes, goods transport, car rental services, and catering;
  6. Agreements related to leisure activities if the agreement provides for a specific date or period of execution;
  7. Products manufactured according to the consumer's specifications, which are not prefabricated and are made based on an individual choice or decision of the consumer, or are clearly intended for a specific person;
  8. Products that spoil quickly or have a limited shelf life;
  9. Sealed products that are not suitable for return for reasons of health protection or hygiene and whose seal has been broken after delivery;
  10. Products that are irrevocably mixed with other products after delivery due to their nature;
  11. Alcoholic beverages whose price has been agreed upon at the conclusion of the agreement but can only be delivered after 30 days, and whose actual value depends on market fluctuations over which the entrepreneur has no influence;
  12. Sealed audio, video recordings, and computer software whose seal has been broken after delivery;
  13. Newspapers, magazines, or magazines, with the exception of subscriptions to them;
  14. The delivery of digital content other than on a tangible medium, but only if:    a. the execution has started with the explicit prior consent of the consumer; and    b. the consumer has declared that they lose their right of withdrawal.

Article 11 - The Price

  1. During the period mentioned in the offer, the prices of the offered products and/or services will not be increased, except for price changes due to changes in VAT rates.
  2. Contrary to the previous paragraph, the entrepreneur can offer products or services whose prices are subject to fluctuations in the financial market and over which the entrepreneur has no influence, with variable prices. This dependency on fluctuations and the fact that any listed 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 result from 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:    a. they result from statutory regulations or provisions; or    b. the consumer has the authority to terminate the agreement with effect from the day on which the price increase takes effect.
  5. The prices mentioned in the offer of products or services include VAT.

Article 12 - Fulfillment of the Agreement and Extra 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 reliability and/or usability, and the statutory provisions and/or government regulations existing on the date of the conclusion of the agreement. If agreed, the entrepreneur also guarantees that the product is suitable for use other than normal.
  2. An extra guarantee provided by the entrepreneur, their supplier, manufacturer, or importer never limits the legal rights and claims that the consumer can assert against the entrepreneur under the agreement if the entrepreneur has failed to fulfill their part of the agreement.
  3. Extra guarantee means any commitment by the entrepreneur, their supplier, importer, or producer in which they grant the consumer certain rights or claims that go beyond what is legally required in the event they have failed to fulfill their part of the agreement.

Article 13 - Delivery and Execution

  1. The entrepreneur will take the greatest possible care when receiving and executing orders for products and when assessing requests for the provision of services.
  2. The place of delivery is the address that the consumer has made known to the entrepreneur.
  3. With due observance of the provisions in Article 4 of these general terms and conditions, the entrepreneur will execute accepted orders with due speed but no later than 30 days unless another delivery period has been agreed. If the delivery is delayed, or if an order cannot be executed or can only be partially executed, the consumer will be notified of this no later than 30 days after they have placed the order. In that case, the consumer has the right to dissolve the agreement without costs and is entitled to any compensation.
  4. After dissolution in accordance with the previous paragraph, the entrepreneur will refund the amount that the consumer has paid without delay.
  5. The risk of damage and/or loss of products rests with the entrepreneur until the moment of delivery to the consumer or a previously designated and announced representative to the entrepreneur, unless expressly agreed otherwise.

Article 14 - Duration Transactions: Duration, Termination, and Extension

Termination:

  1. The consumer can terminate an agreement concluded for an indefinite period and which extends to the regular delivery of products (including electricity) or services at any time with due observance of the agreed termination rules and a notice period of no more than one month.
  2. The consumer can terminate an agreement concluded for a definite period and which extends to the regular delivery of products (including electricity) or services at any time at the end of the definite period with due observance of the agreed termination rules and a notice period of no more than one month.
  3. The consumer can terminate the agreements mentioned in the previous paragraphs:    a. at any time and not be limited to termination at a specific time or in a specific period;    b. at least terminate in the same way as they were concluded;    c. always terminate with the same notice period as the entrepreneur has stipulated for themselves.

Extension:

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

Duration:

  1. If an agreement has a duration 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 dictate otherwise.

Article 15 - Payment

  1. Unless otherwise provided in the agreement or additional conditions, the amounts owed by the consumer must be paid within 14 days after the commencement of the reflection period, or in the absence of a reflection 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 the confirmation of the agreement.
  2. When selling products to consumers, the consumer may never be obliged to make an advance payment of more than 50% in general terms and conditions. When advance payment is stipulated, the consumer cannot assert any right regarding the execution of the relevant order or service(s) before the stipulated advance payment has been made.
  3. The consumer has the duty to report inaccuracies in provided or stated payment details to the entrepreneur without delay.
  4. If the consumer does not fulfill their payment obligation(s) in time, they are, after being reminded by the entrepreneur of the late payment and the entrepreneur has granted the consumer a period of 14 days to still fulfill their payment obligations, after the failure to pay within this 14-day period, owe the statutory interest on the amount still owed, and the entrepreneur is entitled to charge the extrajudicial collection costs incurred by them. These collection costs amount to a maximum of: 15% on outstanding amounts up to €2,500; 10% on the following €2,500; and 5% on the next €5,000 with a minimum of €40. The entrepreneur can deviate from these amounts and percentages for the benefit of the consumer.

Article 16 - Complaints Procedure

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

Article 17 - Disputes

  1. Agreements between the entrepreneur and the consumer to which these general terms and conditions relate are exclusively governed by Dutch law.
  2. Disputes between the consumer and the entrepreneur about the conclusion or execution of agreements related to products and services to be delivered or delivered by this entrepreneur can be submitted by both the consumer and the entrepreneur to the Thuiswinkel Disputes Committee, Postbus 90600, 2509 LP The Hague (www.sgc.nl), subject to the provisions below.
  3. A dispute will only be handled by the Disputes Committee if the consumer has first submitted their complaint to the entrepreneur within a reasonable time.
  4. If the complaint does not lead to a solution, the dispute must be submitted in writing to the Disputes Committee no later than 12 months after the date on which the consumer submitted the complaint to the entrepreneur.
  5. If the consumer wants to submit a dispute to the Disputes Committee, the entrepreneur is bound by this choice. Preferably, the consumer should first notify the entrepreneur.
  6. If the entrepreneur wants to submit a dispute to the Disputes Committee, the consumer must state in writing within five weeks after a written request made by the entrepreneur whether they also wish to do so or prefer the dispute to be handled by the competent court. If the entrepreneur does not hear the consumer's choice within the five-week period, the entrepreneur is entitled to submit the dispute to the competent court.
  7. The Disputes Committee makes a decision under the conditions 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 cease handling it if the entrepreneur has been granted a suspension of payments, has become bankrupt, or has effectively terminated their business before a dispute is handled by the committee at the hearing and a final judgment has been rendered.
  9. If, in addition to the Thuiswinkel Disputes Committee, another recognized or affiliated disputes committee with the Foundation for Consumer Disputes Committees (SGC) or the Financial Services Complaints Institute (Kifid) is competent, the Thuiswinkel Disputes Committee is preferably competent for disputes mainly related to the sales method or remote service delivery. For all other disputes, the other recognized disputes committee affiliated with SGC or Kifid is competent.

Article 18 - Industry Guarantee

  1. Thuiswinkel.org guarantees the fulfillment of the binding advice of the Thuiswinkel Disputes Committee by its members, 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 is upheld after review by the court and the judgment proving this has become final and binding. Up to an amount of €10,000 per binding advice, this amount will be paid to the consumer by Thuiswinkel.org. For amounts greater than €10,000 per binding advice, €10,000 will be paid. For the remainder, Thuiswinkel.org has a best efforts obligation to ensure that the member fulfills the binding advice.
  2. For the application of this guarantee, it is required that the consumer makes a written appeal to Thuiswinkel.org and transfers their claim against the entrepreneur to Thuiswinkel.org. If the claim against the entrepreneur exceeds €10,000, the consumer is offered to transfer their claim for the amount exceeding €10,000 to Thuiswinkel.org, after which this organization will demand payment of the claim in its own name and costs to satisfy the consumer.

Article 19 - Additional or Different Provisions

Additional provisions or provisions that deviate 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 the consumer can store them in an accessible manner on a durable medium.


Article 20 - Amendment of the General Terms and Conditions Thuiswinkel

  1. Thuiswinkel.org will only amend these general terms and conditions in consultation with the Consumers' Association.
  2. Amendments to these conditions are only effective after they have been published in the appropriate manner, provided that during the validity of an offer, the most favorable provision for the consumer will prevail in the event of applicable changes.

Thuiswinkel.org
www.thuiswinkel.org
Horaplantsoen 20, 6717 LT Ede


Appendix I: Model Withdrawal Form

Model Withdrawal Form

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

a. To: [name of entrepreneur]
   [geographical address of entrepreneur]
   [fax number of entrepreneur, if available]
   [email address or electronic address of entrepreneur]

b. I/We* hereby give notice that I/We* withdraw from our contract of sale of the following products: [product description],
   the delivery of the following digital content: [digital content description]
,
   the provision of the following service: [service description]*,

c. Ordered on*/received on* [date of order for services or receipt for products]

d. [Name of consumer(s)]

e. [Address of consumer(s)]

f. [Signature of consumer(s)] (only if this form is notified on paper)

g. [Date]

*Delete as appropriate or fill in as applicable.


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