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(Complete this form and return it only when you want to revoke the agreement)


-       To: E-njoint B.V.

              Rotterdamseweg 400

              2629 HH Delft

              The Netherlands




-       I/We hereby inform you that I/we wish to revoke our agreement  on the sale of the following products:

[specification of the product]*




-       Ordered on*/received on* (dd/mm/yy)

-       Order Number / Order Reference :

-       [Your name]

-       [Your address]

-       [Your signature] (only when this form is submitted on paper)



*) Delete and/or complete where appropriate.