General conditions

CRUISE WITH US B.V.

Version dated October 6, 2026 — applies to bookings made on or after that date and replaces the version dated August 10, 2026

Download the terms and conditions as a PDF

‍Cancel this agreement here

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In a nutshell

This summary will help you get started; the articles below contain the relevant information.

• You can book your cruise with Cruise With Us B.V. We sail on the Prins van Oranje, MS De Jordaan, the Soeverein, and the Valentijn.
• Cruise, package tour, or private charter on a fixed date: no statutory cooling-off period. Cancellation is permitted, however, in accordance with Article 9.
• Gift cards purchased online: 14-day statutory cooling-off period. Tickets without a fixed date: 14-day cooling-off period provided by us (Article 4). Gift cards are valid for 2 years.
• Cancellation of public cruises: free of charge up to 3 weeks before departure; 50% (or a 100% gift certificate) from 3 weeks to 48 hours before departure; 100% thereafter. If we are able to resell your seats, you will receive a 75% refund.
• Cancellation of a private charter: free of charge up to 8 weeks before the trip; 50% from 8 to 4 weeks; 75% from 4 weeks to 7 days; 100% thereafter.
• We deduct a 3% administrative fee from refunds for cancellations made within the 50% and 75% cancellation windows; this does not apply to free cancellations or if you choose the gift card option.
• If we cancel (due to weather, water, technical issues, or insufficient participants), we'll offer an alternative or refund your money within 14 days.
• For personal injury, baggage, and delays, the statutory rules for passenger transport on inland waterways apply; we do not impose any limitations on these. For other types of damage, the maximum coverage is €10,000 per incident.
• Be sure to board 15 minutes before departure; the captain has the final say regarding safety; no outside drinks allowed, and no alcohol for those under 18.

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Article 1 — Who We Are, Who You Are

1.1. We are Cruise With Us B.V., located at Danzigerkade 40, 1013 AP Amsterdam, registered with the Chamber of Commerce under number 55826326, VAT identification number NL851875166B01. In these terms and conditions, we refer to ourselves as “we” or “Cruise With Us.”

1.2. We are your contracting party for all bookings: public cruises, tickets, packages, and private charters. This also applies if the cruise takes place on a vessel owned by one of our sister companies: Salonboot Prins van Oranje B.V. (Prins van Oranje), MS De Jordaan B.V. (MS De Jordaan), Salonboot Soeverein B.V. (Soeverein), and Salonboot Valentijn B.V. (Valentijn). These sister companies and our parent company, De Vereenigde Amsterdamsche Reederij B.V., are not parties to your agreement and are not liable under it, unless otherwise provided by law.

1.3. Only if we expressly state this in the offer or quotation prior to booking will another company within our group be your contracting party. Its name, address, and Chamber of Commerce number will then be listed in the offer or quotation as well as in the booking confirmation, and in these terms and conditions, “we” refers to that company. An invoice or confirmation issued after the fact cannot change the contracting party.

1.4. By “you,” we mean the customer: the person who makes a reservation or accepts an offer. You are a consumer if you make a reservation as a private individual and not for your profession or business. Otherwise, you are a business customer; Article 15 applies additionally to business customers.

1.5. If you are booking (in part) for others, you warrant that you are authorized to do so, you will provide them with these terms and conditions and our safety instructions, and you will serve as our point of contact for the entire group. We refer to anyone traveling as part of your booking as a passenger.

1.6. Other terms used in these terms and conditions:

• public cruise: a cruise with a fixed date, time, and route for which we sell individual seats (tickets);
• private charter: the exclusive use of a vessel, or part thereof, by you and your party on an agreed date and time, with or without catering and other services;
• package: a boat tour combined with catering, entertainment, or other services that we put together;
• ticket: our (electronic) confirmation granting access to a public cruise;
• booking confirmation: our email or other message in which we confirm your booking, including the details of the cruise, the price, and these terms and conditions;
• in writing: by mail, by email, or through our booking system.

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Article 2 — When Do These Terms Apply?

2.1. These terms and conditions apply to all of our offers, quotes, reservations, tickets, gift certificates, packages, and agreements.

2.2. We will provide you with these terms and conditions before or no later than the time the agreement is concluded. For online bookings, you can read and save them during the booking process, and you will receive them as a PDF attachment with your booking confirmation so that you can keep a copy. For quotes, we will send them as an attachment. You can also always find them at www.cruisewithus.nl.

2.3. In the event of a conflict, the following order of precedence applies: (a) mandatory law; (b) the terms set forth in your booking confirmation or quote; (c) these terms and conditions.

2.4. A customer’s own (purchasing) terms and conditions do not apply unless we have accepted them in writing. Any deviations from these terms and conditions are valid only if we have confirmed them in writing.

2.5. If you book through a sales platform or intermediary (such as an online ticketing platform or a hotel), the terms and conditions of that platform apply only to the services the platform itself provides to you. These terms and conditions apply to your agreement with us. If, prior to booking, the platform displays payment or cancellation terms that are more favorable to you than those set forth in Article 6 or 9, those more favorable terms shall apply.

2.6. If any provision of these terms and conditions is invalid, the remaining provisions shall remain in effect. In the event of any discrepancy between the Dutch text and a translation, the Dutch text shall prevail.

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Article 3 — Offer, Reservation, and Formation of the Contract

3.1. In our offer—on the website, in the booking system, or in a quote—we specify, where applicable: who your contracting party is; what the cruise entails; the date, time, duration, and boarding location; the total price, including VAT and all mandatory fees; how and when you pay; our cancellation policy; whether you have a statutory cooling-off period; and special conditions such as age, safety, or accessibility.

3.2. An offer is nonbinding until we have confirmed your booking. Obvious errors or mistakes—such as a clearly incorrect price—are not binding on us if you could reasonably have recognized that it was an error.

3.3. Public cruises: The agreement is concluded as soon as we confirm your reservation, either by email or with a ticket. For online reservations, you pay immediately upon booking.

3.4. Private charters and packages based on a quote: The agreement is concluded as soon as you have accepted our quote in writing and we have confirmed the booking. An option on a date is non-binding and automatically expires after the period specified in the option confirmation.

3.5. Online booking: Just before you complete the booking, you will see the details of the cruise, the total price, the date and time, the cancellation policy, and whether you have a cooling-off period. The button used to complete the booking clearly indicates that you are entering into a payment obligation. You will then immediately receive a booking confirmation via email, with these terms and conditions attached as a PDF.

3.6. We may refuse a booking if the cruise is unavailable, if essential safety requirements cannot be met, or if we have another valid reason to do so. We will notify you as soon as possible and immediately refund any amount you have already paid.

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Article 4 — Cooling-off Period (Right of Withdrawal)

4.1. If, as a consumer, you book a cruise, package, or private charter for a specific date or during a specific period, you do not have a statutory cooling-off period. The law excludes leisure activities on a fixed date from the right of withdrawal. We will inform you of this before you book. Cancellation is still possible; in that case, Article 9 applies.

4.2. If you, as a consumer, purchase a gift card online, you have a statutory cooling-off period of 14 days, starting from the day after you receive the confirmation. If you purchase a ticket online without a fixed date, we grant you the same 14-day cooling-off period—even though the law does not require us to do so for passenger transportation. You may cancel your purchase by sending an email to info@cruisewithus.nl, using the form at the bottom of these terms and conditions, or using the cancellation feature on our website; we will immediately confirm receipt via email. We will issue a full refund within 14 days, free of charge, via the same payment method. If you use the voucher or ticket (in part) within the cooling-off period, you are thereby expressly requesting that we fulfill the contract: the cooling-off period expires for the portion used; we will refund the unused portion upon cancellation.

4.3. Business customers do not have a cooling-off period.

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Article 5 — Prices

5.1. Our prices for consumers are in euros and include VAT and all mandatory fees, including the municipal tax per passenger. For a private charter or package, the quote specifies exactly what is included in the price and which costs will be billed afterward based on actual usage—for example, refreshments, additional guests, extra sailing time, or the fee per passenger actually present—at the prices and rates listed in the quote.

5.2. For a public cruise, the price in effect at the time of booking applies; for a private charter or package, the price in the confirmed quote applies. We will not increase the price after booking, unless the VAT rate or a government tax changes, in which case we will increase the price only by the amount of that change. If we increase the price, you may cancel the booking free of charge; you will then receive a full refund. If a price increase cannot be legally applied, the original price will remain in effect.

5.3. If we charge fees for a payment method, those fees will be listed before the transaction is processed and will not exceed our actual costs.

5.4. For business customers, we specify in the quote whether the prices include or exclude VAT.

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Article 6 — Payment

6.1. Public cruises: You pay at the time of booking, using the payment methods available in our booking system.

6.2. Private charters and packages based on a quote, unless otherwise stated in the quote: 50% of the price within 7 days of the booking confirmation; the remainder no later than 3 weeks before the cruise; costs based on actual expenses must be paid within 14 days of the invoice date. If you book within 3 weeks before the cruise, you must pay the full amount immediately.

6.3. If you do not pay on time, we will first send you a written reminder at no charge, granting you a 14-day grace period starting the day after receipt. If you are a consumer and still fail to pay within that period, we will charge statutory interest and extrajudicial collection costs in accordance with the statutory scale; the exact amount of collection costs owed will be specified in the reminder. For business customers, Article 15 applies.

6.4. If payment is still not received after the reminder, we may suspend the cruise or cancel the reservation. In that case, the cancellation policy set forth in Article 9 will apply as if you had canceled.

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Article 7 — Your Information, Attendance, and Changes

7.1. You must provide us with the correct information we need for the cruise in a timely manner: names and number of passengers, contact information, allergies and dietary restrictions, and any special circumstances such as limited mobility. You must provide information regarding allergies and dietary restrictions at the time of booking and no later than 7 days before the cruise; if you book later than that, you must provide this information immediately upon booking. If anything changes, please let us know right away.

7.2. You must inform your fellow passengers about the reservation, these terms and conditions, and our safety instructions.

7.3. You and your party must be at the boarding location specified in the confirmation no later than 15 minutes before departure. The ship departs at the agreed-upon time. If you arrive late, we can only allow you to board if it can be done safely without delaying the voyage. If the ship has already departed, this will be considered a no-show (Article 9).

7.4. If you wish to make any changes—such as the date, time, number of guests, catering, or other details—please submit your request in writing. A change is not valid until we have confirmed it in writing; we will take availability, scheduling, and safety into account. A change may result in a different price; we will notify you of this in advance.

7.5. Private Charter: You must provide the final number of passengers no later than 10 days before the cruise. Any reduction in the number of passengers after that date will be considered a partial cancellation for the portion of the price calculated per person (Article 9). If more passengers arrive than agreed upon, and if it is safe and practically feasible, we will charge for the additional passengers and refreshments at the prices listed in the quote.

7.6. Rescheduling public cruises: Up to 48 hours before departure, you may reschedule a ticket for a public cruise once, free of charge, to another date within 12 months, provided there is availability. We will adjust for any price difference. If you subsequently cancel a rebooked ticket, we will charge the fee specified in Article 9 based on the tier that applied on the day of the rebooking, unless a higher tier applies on the day of cancellation.

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Article 8 — Gift Certificates

8.1. A gift certificate lists its value, date of issue, validity period, and instructions on how to use it. A gift certificate is valid for at least 2 years from the date of issue; the expiration date is printed on the certificate.

8.2. A gift certificate cannot be redeemed for cash. If the value of the certificate exceeds the cost of your reservation, the remaining balance will remain on the certificate until its expiration date.

8.3. The cooling-off period specified in Article 4.2 applies to gift cards purchased online.

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Article 9 — Cancellation by You

9.1. You must cancel in writing, either by email to info@cruisewithus.nl or through our booking system. The time we receive your cancellation determines which policy applies.

9.2. Public transportation and tickets:

• Up to 3 weeks before departure: free of charge; you will receive a full refund;
• From 3 weeks to 48 hours before departure: you pay 50% of the price; we will refund 50%, minus a 3% administrative fee (Article 9.5) — or, if you prefer, a gift certificate worth 100% of the amount paid, valid for 2 years and with no administrative fees; please indicate your choice at the time of cancellation. If you do not use that gift certificate before its expiration date, you may still request the amount to which you were entitled at the time of cancellation (50%, minus a 3% administrative fee);
• Within 48 hours before departure or in case of a no-show: you will be charged 100%.

9.3. If we sell the seats you have released to someone else before the cruise, the following applies instead of the scale in 9.2: you will receive a refund of 75% of the amount paid for those seats, minus a 3% administrative fee—even if you canceled within 48 hours before departure. The 25% we retain is our compensation for the costs of the resale and the risk we bore until the resale took place; we do not charge anything in addition to this. This does not apply if you opted for the gift certificate. Upon request, we will show you whether and when the seats were sold.

9.4. Private charter and package based on a quote (the total price is the price listed in the quote, excluding any costs billed after the fact):

• Up to 8 weeks before the cruise: no charge; you will receive a full refund;
• From 8 to 4 weeks before the cruise: 50% of the total price; any amount you paid in excess of this will be refunded, minus a 3% administrative fee;
• From 4 weeks to 7 days before the cruise: 75% of the total price; any amount you paid in excess will be refunded, minus a 3% administrative fee;
• Within 7 days before the cruise or in case of a no-show: 100% of the total price.

We will not charge you twice for costs we have already incurred with third parties at your request and cannot reverse—such as artists booked specifically for the event or products purchased—if those costs exceed the percentage of your cancellation fee, you will pay those costs instead of the percentage, and never more than the total price. This applies only to costs specified as non-refundable in the quote. If we are able to rent the boat to another party on the canceled date, we will deduct the net proceeds from your payment; you will then pay at least 25% of the total price as compensation for our costs and the risk we have borne. Upon request, we will provide proof of whether the vessel was chartered and the amount it generated.

9.5. Administrative Fees: For refunds following a cancellation, we will withhold 3% of the amount you paid to cover the administrative and transaction costs associated with processing and refunding your payment. This does not apply to cancellations made free of charge (the first stage of sections 9.2 and 9.4), if you opt for a gift card, or if no refund is issued. The 3% is our estimate of those costs (the payment provider’s transaction fees, which are not credited upon refund, and processing fees); upon request, we will provide a breakdown. Example: You paid €100 and cancel 10 days before departure; you will receive a refund of €50 minus €3 in administrative fees, for a total of €47.

9.6. The percentages and administrative fees are not a penalty, but a fixed, reasonable compensation for the costs we have already incurred and the revenue we are losing, taking into account the savings we realize and the likelihood that we will resell the vessel or berths. We do not charge any other cancellation fees.

9.7. The percentages and administrative costs are preliminary estimates. If our actual damages in your case are lower, you, as a consumer, will pay only those lower damages; upon request, we will show you how we calculated the compensation and what costs we saved or what revenue we subsequently generated. This does not alter the legal rules regarding who must prove what.

9.8. If the law entitles you to free cancellation or a refund in a specific case—for example, with a package tour—then the law takes precedence.

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Article 10 — Cancellation or Modification by Us

10.1. We may cancel or modify a cruise if sailing is unsafe or imprudent, or if the cruise cannot reasonably proceed. Examples include: storms, fog, ice, high or low water, and other nautical conditions; obstructions, bridges, and locks; instructions from authorities and government measures; a technical malfunction that we were unable to prevent or repair in time despite regular maintenance; illness or absence of crew members whom we cannot replace in time; or an insufficient number of participants for a public cruise. Cancellation due to an insufficient number of participants is only possible if we have specified the minimum number for that cruise prior to booking, and no later than 48 hours before departure; if we have not specified a minimum, the cruise will proceed; if we do cancel, sections 10.3 and 10.6 apply. “Cannot reasonably proceed” is not a free pass: we will cancel only for a specific reason that we will communicate to you.

10.2. We will notify you immediately using the contact information provided in your reservation.

10.3. In the event of a cancellation, we will, if possible, offer an alternative: a different date, a different time, or a comparable vessel. If you do not wish to accept the alternative or if there is no suitable alternative, we will refund the full amount paid within 14 days, without any administrative fees, via the same payment method. You will only receive a credit or gift certificate instead of a cash refund if you specifically request it.

10.4. We may use a comparable vessel. In the event of a material change—such as a different vessel that is not comparable, a different day, a departure time that shifts by more than one hour, or the cancellation of an essential part of the package—you may cancel the reservation free of charge; we will then refund the amount you paid without charging any administrative fees. Minor adjustments to the route, sailing time, or boarding location for nautical, safety, or operational reasons do not entitle you to cancellation or a refund.

10.5. Force majeure refers to circumstances beyond our control: extreme weather, ice, fog, high or low water levels, road closures, instructions from authorities and government measures, war, terrorism, pandemics, strikes outside our company, infrastructure failures, and a technical malfunction that we were unable to prevent or remedy in a timely manner despite regular maintenance and reasonable precautions. Insufficient participants, scheduling errors, and crew absences that we could have accommodated do not constitute force majeure. In cases of force majeure, we are not liable for additional damages, such as travel and accommodation costs, lost profits, or other consequential damages, to the extent permitted by law. Your right to a refund remains in effect at all times.

10.6. If we cancel for a reason attributable to us, you will also retain your statutory rights.

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Article 11 — On Board: Safety and House Rules

11.1. The captain is responsible for safety and makes all decisions related to it. You must immediately follow the instructions of the captain and crew.

11.2. The route, sailing time, and boarding location may be adjusted for safety, nautical, or operational reasons, even during the voyage. We will notify you as soon as reasonably possible.

11.3. We may refuse entry to anyone or ask them to disembark during the cruise in the event of dangerous, aggressive, intimidating, or disruptive behavior; failure to follow instructions; severe intoxication; use or possession of drugs; or (imminent) damage. If this occurs for a reason attributable to you or that passenger, you will not receive a refund, and we may recover from you any damages and additional costs incurred as a result.

11.4. Without our prior written consent, the following items are not permitted on board: personal food and beverages, glassware, confetti, rice, fireworks, smoke machines, helium balloons, weapons, hazardous substances, and other items that could cause fire, pollution, or damage.

11.5. Alcohol: We do not serve alcohol to anyone under the age of 18 and may ask to see identification. We may refuse to serve alcohol to anyone who, in our judgment, has had too much to drink.

11.6. Smoking, including e-cigarettes, is permitted only outdoors on the open deck in the area designated by the crew; smoking is prohibited indoors.

11.7. Children must be supervised by an adult in your party throughout the entire cruise. Life jackets are available on board; if the captain determines that children or non-swimmers must wear a life jacket, they must do so.

11.8. Accessibility: Our ships vary in terms of accessibility, and not every ship is wheelchair-accessible; at www.cruisewithus.nl, you can find details on each ship’s accessibility (boarding location, stairs, restroom). If you or one of your guests has a disability, please let us know before booking; we assess each request individually, make reasonable accommodations where possible, and provide honest information about what is possible on each ship. No one will be refused boarding without this assessment. Service dogs are always welcome; other pets are allowed only after prior consultation.

11.9. Damage to the vessel, its contents, or other property belonging to us or to third parties caused by you, your guests, or suppliers you have engaged is your responsibility to the extent that such damage is attributable to them, including reasonable costs for repairs and additional cleaning. For a private charter, we may require a security deposit; the amount is specified in the quote. We will refund the security deposit within 14 days after the cruise, less any itemized costs for which you are responsible.

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Article 12 — Liability

12.1. We operate the cruise with the care you would expect from a professional shipping company. In the event of death or injury to passengers, damage to luggage, or delays, the statutory rules governing passenger transport on inland waterways apply, including the maximum amounts specified therein and the rule that we may not invoke any limitation of liability in cases of willful misconduct or gross negligence. These terms and conditions do not limit that statutory liability nor do they shift the statutory burden of proof.

12.2. For other damages that are the direct result of a breach attributable to us, our liability is limited to €10,000 per occurrence. If our insurer pays out a higher amount for that occurrence, that higher amount shall apply.

12.3. We are not liable for indirect damages, such as consequential damages, lost profits, lost savings, and travel and lodging expenses, unless the damages result from willful misconduct or gross negligence on our part or on the part of our officers.

12.4. You bring personal belongings at your own risk. We are liable for loss, theft, or damage only if it is attributable to us or if required by law. As required by law, we are not liable for cash, jewelry, or other valuables unless you have entrusted them to us for safekeeping.

12.5. The limitations set forth in this section do not apply to the extent that they are prohibited by law, nor if invoking them would be unreasonable under the circumstances.

12.6. If a third party makes a claim against us for damages caused by you, your guests, or third parties engaged by you, you shall indemnify us against such claims, unless the damages are attributable to us. In that case, we will notify you in a timely manner and involve you in our defense.

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Article 13 — Complaints

13.1. If something is wrong, please let the crew know right away; we can often fix it on the spot.

13.2. Please submit any complaints after the cruise, preferably within 30 days of the cruise, to info@cruisewithus.nl, including your booking number, the date of the cruise, and a description. If you file a complaint later than that, you will not automatically lose your rights; however, it will be more difficult for us to properly assess the complaint.

13.3. We will acknowledge receipt and respond to the substance of your inquiry within 14 days. If we need more time, we will let you know within that period when you can expect a response.

13.4. If your complaint is valid, we will offer an appropriate solution: repair, a partial refund, a gift card, or other reasonable compensation, commensurate with the nature and extent of the defect. You are not required to accept a gift card in lieu of a cash refund.

13.5. We are not affiliated with any dispute resolution board. If we are unable to reach a mutual agreement, you may take the matter to court (Article 17).

13.6. Claims are subject to the statutory limitation periods; these terms and conditions do not shorten any statutory limitation or expiration period.

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Article 14 — Privacy, Photos, and Videos

14.1. We process your personal data for booking, payment, the operation of the cruise, safety, our administration, and our customer service, in accordance with privacy legislation (GDPR). How we do this—including which cameras we use on board, on what grounds, and how long we retain footage—is outlined in our privacy policy at www.cruisewithus.nl (link at the bottom of every page).

14.2. If you provide us with information about fellow passengers, you warrant that you are authorized to do so and that you have informed them of our privacy policy.

14.3. We may take and use atmospheric photos on board in which individuals are not individually recognizable. We will only use recognizable photos or videos of you for marketing purposes if you have given your separate and explicit consent in advance. You may withdraw that consent at any time by contacting the crew or via info@cruisewithus.nl; for children, we request consent from a parent or legal guardian. Failure to give consent will in no way affect your participation.

14.4. For security purposes, there may be cameras on board; this will be indicated on board.

14.5. Questions about privacy or visual material: info@cruisewithus.nl. You can always file a complaint with the Dutch Data Protection Authority.

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Article 15 — Business Customers

15.1. Provisions that protect only consumers do not apply to business customers, unless otherwise provided by law. For business customers, the terms set forth in the quote take precedence over these terms and conditions.

15.2. You must report any objections to an invoice within 14 days of the invoice date; after that, the invoice is deemed accepted, unless you could not reasonably have discovered the error earlier.

15.3. If you pay late, you will owe statutory commercial interest from the due date, as well as extrajudicial collection costs as provided by law.

15.4. If you resell our boat tours to your own guests—for example, as a hotel, event agency, or tour operator—you must ensure that your guests are familiar with our house rules and safety instructions, and you remain responsible to us for your guests.

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Article 16 — Package Tours

16.1. A day trip or evening cruise without an overnight stay does not constitute a package tour. If, at your request, we combine a cruise with an overnight stay or another travel service into a single package, the statutory rules for package tours apply; those rules take precedence over these terms and conditions where they differ.

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Article 17 — Governing Law, Jurisdiction, and Amendments to These Terms and Conditions

17.1. All of our offers and agreements are governed by Dutch law. If you are a consumer and reside in another country, you retain the protection afforded by that country’s mandatory rules to the extent that the law grants it to you.

17.2. We will submit disputes to the court that has jurisdiction under the law. For business customers, this is the Amsterdam District Court, to the extent that the law permits such a choice. If you are a consumer, the court designated by law shall have jurisdiction.

17.3. We may amend these terms and conditions for new bookings, for example, in the event of changes in legislation or business operations. The version you received at the time of booking applies to your booking. The current version, including the date, is always available at www.cruisewithus.nl.

17.4. Contact: Cruise With Us B.V., Danzigerkade 40, 1013 AP Amsterdam, info@cruisewithus.nl, 020 774 27 64.

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Appendix — Sample Withdrawal Form

Applies only to gift cards and tickets purchased online that do not have a fixed date (Section 4.2). Please complete and return this form only if you wish to cancel the agreement. You may also complete and submit this form online using the cancellation feature at www.cruisewithus.nl (link at the bottom of each page); we will then immediately confirm receipt of your cancellation via email.

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Cancel this agreement here (online form)

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To: Cruise With Us B.V., Danzigerkade 40, 1013 AP Amsterdam, info@cruisewithus.nl

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I/We (*) hereby notify you that I/we (*) am/are (*) withdrawing from our contract regarding the sale of the following goods/provision of the following service (*): ……………………………………

Ordered on (*) / Received on (*): ……………………

Name(s) of consumer(s): ……………………………………

Consumer(s)' address: ……………………………………

Signature(s) of the consumer(s) (only if this form is submitted on paper): ……………………

Date: ……………………

(*) Delete as appropriate.

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