Revocation form

Attention! (only fill in and resend if you want to rescind on your purchase).

To Assyriological Centre Georges Dossin
Jubelpark 10
1000 Brussel

choose...IWe hereby announce that I / we cancel our agreement regarding the sale of this/these choose...productproducts

Order date: *

Delivery date: *

Ref. number order: *

Articles ref.: *

Name /names buyer(s): *

Adress: *

Country: *

IBAN: *

BIC:

Email: *

Date: *

ik ben geen robot:: *

7 + 5 =

You will receive a confirmation after receipt of this form.