TERMS AND CONDITIONS


INDEX:

Article 1 - Definitions
Article 2 - Identity of the entrepreneur
Article 3 - Registration and use of mosaiquealamaison.nl
Article 4 - Applicability
Article 5 - The offer
Article 6 - The agreement
Article 7 - Right of withdrawal
Article 8 - Obligations of the consumer during the reflection period
Article 9 - Exercise of the right of withdrawal by the consumer and costs thereof
Article 10 - Obligations of the entrepreneur in case of withdrawal
Article 11 - Exclusion of right of withdrawal
Article 12 - Gift cards and vouchers
Article 13 - The price
Article 14 - Compliance and extra guarantee
Article 15 - Delivery and implementation
Article 16 - Duration transactions: duration, cancellation and extension
Article 17 - Payment
Article 18 - Complaints procedure
Article 19 - Additional or deviating provisions
Article 20 - Data security

ARTICLE 1 - DEFINITIONS
  1. Additional agreement: an agreement whereby the consumer acquires products, digital content and / or services in connection with a distance contract and these goods, digital content and / or services are provided by the entrepreneur or by a third party on the basis of an agreement between that third party and the entrepreneur;
  2. Reflection period: the period within which the consumer can make use of his right of withdrawal;
  3. Consumer: the natural person who does not act for purposes related to his trade, business, craft or professional activity;
  4. Day: calendar day;
  5. Digital content: data that is produced and delivered in digital form;
  6. Duration agreement: an agreement that extends to the regular delivery of goods, services and / or digital content during a certain period;
  7. Durable medium: any tool - including e-mail - that enables the consumer or entrepreneur to store information that is addressed to him personally in a way that facilitates future consultation or use during a period that is geared to the purpose. for which the information is intended and which allows unaltered reproduction of the stored information;
  8. Right of withdrawal: the possibility for the consumer to cancel the distance contract within the cooling-off period;
  9. Entrepreneur: the natural or legal person who offers products, (access to) digital content and / or services to consumers from a distance;
  10. Distance contract: an agreement 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 partial use is made up to and including the conclusion of the agreement. uses one or more remote communication techniques;
  11. Model withdrawal form: the European model withdrawal form included in Appendix I of these terms and conditions. Annex I does not have to be made available if the consumer does not have a right of withdrawal with regard to his 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 room at the same time.
ARTICLE 2 - IDENTITY OF THE ENTREPRENEUR

The internet portal www.mosaiquealamaison.nl as well as the online shop integrated therein (hereinafter jointly referred to as 'website'), is operated by Mosaique A La Maison, Die Europa-Allee 7b, Frankfurt am Main, 60327, Duitsland (hereinafter referred to as 'Mosaique A La Maison' or 'we').

Name of entrepreneur: Mosaique A La Maison
Trading under the name: Mosaique A La Maison

Business address (no visiting address and no returns):
Europa-Allee 7b
60327 Frankfurt am Main
Duitsland
(no return address)

Accessibility: maandag t/m vrijdag van 9:00 uur tot 17:00 uur.
E-mail address: klantenservice@mosaiquealamaison.nl

If the activity of the entrepreneur is subject to a relevant licensing system: the details of the supervisory authority.
If the entrepreneur practices a regulated profession:

  • the professional association or organization with which he is affiliated;
  • the professional title, the place in the EU or the European Economic Area where it is awarded;
  • a reference to the professional rules that apply in the Netherlands and instructions where and how these professional rules are accessible.
ARTICLE 3 - REGISTRATION AND USE OF MOSAIQUEALAMAISON.NL
  1. When you order goods and / or create a customer account, you will be asked to register and provide your personal details. Section 20.1 applies. You are responsible for ensuring that the information is complete and truthful. If during the period of your use there is a change in the information provided, you can adjust the information in your customer account. After completing the registration process, you will receive confirmation of your registration by email. By registering in the online shop mosaiquealamaison.com you also have access to the shopping community of the internet portal www.mosaiquealamaison.nl.
  1. You are responsible for the content (such as product reviews) that you post in the accessible areas. You guarantee that your own content will not infringe or infringe the rights of third parties (such as personal or copyrights). In this regard, you fully indemnify Mosaique A La Maison against claims from third parties upon first request. With the transfer of the content to Mosaique A La Maison, you grant Mosaique A La Maison all obvious user rights unlimited in time, space and content and also for the transfer to third parties. Mosaique A La Maison grants itself the right to publish and distribute the content, also in parts, in their online shops (at mosaiquealamaison.nl, mosaiquealamison.de, mosaiquealamaison.com). Mosaique A La Maison is authorized, but not obliged, to store, publish, delete, edit, correct or translate such content.
ARTICLE 4 - APPLICABILITY
  1. These general terms and conditions apply to any offer from the entrepreneur and to any distance contract concluded between the entrepreneur and the consumer.
  2. Before the distance contract is concluded, the text of these general terms and conditions will be made available to the consumer. If this is not reasonably possible, before the distance contract is concluded, it will be indicated that the general terms and conditions can be viewed at the entrepreneur and that they will be sent free of charge as soon as possible at the request of the consumer.
  3. If the distance contract is concluded electronically, by way of derogation from the previous paragraph and before the distance contract 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 can be easily stored on a durable data carrier. If this is not reasonably possible, before the distance contract is concluded, it will be indicated where the general terms and conditions can be inspected electronically and that they will be sent free of charge at the consumer's request 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 rely on the applicable provision that is most favorable to him in the event of conflicting general terms and conditions. is.
ARTICLE 5 - THE OFFER
  1. If an offer has a limited period of validity or is made subject to conditions, this will be explicitly stated in the offer.
  2. The offer contains a complete and accurate description of the products and / or services offered. The description is sufficiently detailed to enable the consumer to make a proper assessment of the offer. If the entrepreneur uses images, these are a true representation of the products and / or services offered. Possible mistakes or 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 accepting the offer. This concerns in particular:
  4. the price including taxes;
  5. the possible costs of delivery;
  6. the way in which the agreement will be concluded and which actions are required for this;
  7. whether or not the right of withdrawal applies;
  8. the method of payment, delivery and implementation of the agreement;
  9. the term for accepting the offer, or the term within which the entrepreneur guarantees the price;
  10. the level of the rate for distance communication if the costs of using the technique for distance communication are calculated;
  11. on a basis other than the regular basic rate for the means of communication used;
  12. whether the agreement will be filed after the conclusion, and if so, how it can be consulted by the consumer;
  13. the way in which the consumer, before concluding the agreement, can check the information provided by him under the agreement and, if necessary, restore it
  14. any other languages ​​in which, in addition to Dutch, the agreement can be concluded;
  15. the behavioral codes to which the entrepreneur is subject and the way in which the consumer can consult these behavioral codes electronically;
  16. the minimum duration of the distance contract in the event of a length transaction.
ARTICLE 6 - THE AGREEMENT
  1. Subject to the provisions of paragraph 4, the agreement is concluded at the time of acceptance by the consumer of the offer and compliance with the corresponding conditions.
  2. If the consumer has accepted the offer electronically, the trader will immediately confirm receipt of the acceptance of the offer electronically. 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 ensure a safe web environment. If the consumer can pay electronically, the entrepreneur will take appropriate security measures.
  4. The entrepreneur can - within legal frameworks - inform himself whether the consumer can meet his payment obligations, as well as all those facts and factors that are important for a responsible conclusion of the distance contract. If, on the basis of this investigation, the entrepreneur has good reasons not to enter into the agreement, he is entitled to refuse an order or request, with reasons, or to attach special conditions to the implementation.
  5. At the latest upon delivery of the product, service or digital content to the consumer, the entrepreneur will send the following information in writing or in such a way that it can be stored by the consumer in an accessible manner on a durable medium:
  6. the visiting address of the establishment of the entrepreneur where the consumer can go with complaints;
  7. the conditions under which and the way in which the consumer can make use of the right of withdrawal, or a clear statement regarding the exclusion of the right of withdrawal;
  8. information about guarantees and existing service after purchase;
  9. the price, including all taxes on the product, service or digital content; insofar as applicable, the costs of delivery; and the method of payment, delivery or implementation of the distance contract;
  10. the requirements for terminating the agreement if the agreement has a duration of more than one year or is indefinite;
  11. if the consumer has a right of withdrawal, the model withdrawal form.
  12. In the event of an extended transaction, the provision in the previous paragraph applies only to the first delivery.
ARTICLE 7 - RIGHT OF WITHDRAWAL
  1. The consumer can dissolve an agreement regarding the purchase of a product during a cooling-off period of 14 days without giving reasons. The entrepreneur may ask the consumer about the reason for the withdrawal, but not oblige him to state his reason (s).
  2. The reflection period referred to in paragraph 1 starts on the day after the consumer, or a third party designated in advance by the consumer, who is not the carrier, has received the product, or:
  3. if the consumer has ordered several products in the same order: the day on which the consumer, or a third party designated by him, received the last product. The entrepreneur may, provided he has clearly informed the consumer about this prior to the ordering process, refuse an order for several products with different delivery times.
  4. if the delivery of a product consists of several shipments or parts: the day on which the consumer, or a third party designated by him, received the last shipment or the last part;
  5. in the case of contracts for regular delivery of products during a certain period: the day on which the consumer, or a third party designated by him, has received the first product.
ARTICLE 8 - OBLIGATIONS OF THE CONSUMER DURING THE WITHDRAWAL PERIOD
  1. During the reflection period, the consumer will handle the product and packaging with care. He will only unpack or use the product to the extent necessary to determine the nature, characteristics and operation of the product. The starting point here is that the consumer may only handle and inspect the product as he would be allowed to do in a store.
  2. The consumer is only liable for the depreciation of the product that is the result of a way of handling the product that goes further than permitted in paragraph 1.
  3. The consumer is not liable for the depreciation of the product if the entrepreneur has not provided him with all legally required information about the right of withdrawal before or at the conclusion of the agreement.
ARTICLE 9 - EXERCISE OF THE RIGHT OF WITHDRAWAL BY THE CONSUMER AND ITS COSTS
  1. If the consumer makes use of his right of withdrawal, he must report this to the entrepreneur within the reflection period by means of the model withdrawal form or in another unambiguous manner.
  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 (an authorized representative of) the entrepreneur. This is not necessary if the entrepreneur has offered to collect the product himself. The consumer has in any case complied with the return period if he returns the product before the cooling-off period has expired.
  3. The consumer returns the product with all accessories supplied, if reasonably possible in its original condition and packaging, and in accordance with the reasonable and clear instructions provided by the entrepreneur.
  4. The risk and the 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 must bear these costs or if the entrepreneur indicates that he will bear the costs himself, the consumer does not have to bear the costs for return.
  6. If the consumer withdraws after having first explicitly requested that the provision of the service or the supply of gas, water or electricity that have not been made ready for sale in a limited volume or specific quantity commences during the reflection period, the consumer is the entrepreneur a amount due that is proportional to that part of the obligation that has been fulfilled by the entrepreneur at the time of withdrawal, compared to full compliance with the obligation.
  7. The consumer does not bear any costs for the performance of services or the supply of water, gas or electricity, which have not been made ready for sale in a limited volume or quantity, or for the supply of district heating, if:
  8. the entrepreneur, the consumer has not provided the information required by law about the right of withdrawal, the allowance for withdrawal and the model withdrawal form or;
  9. the consumer has not explicitly requested the start of the execution of the service or the supply of gas, water, electricity or district heating during the reflection period.
  10. The consumer does not bear any costs for the full or partial delivery of digital content not supplied on a tangible medium, if:
  11. he has not prior to its delivery expressly agreed to the start of the fulfillment of the agreement before the end of the grace period;
  12. he has not acknowledged that he has lost his right of withdrawal when giving his consent; or
  13. the entrepreneur has failed to confirm this statement from the consumer.
  14. If the consumer exercises his right of withdrawal, all additional agreements will be dissolved by operation of law.
ARTICLE 10 - OBLIGATIONS OF THE ENTREPRENEUR IN CASE OF WITHDRAWAL
  1. If the entrepreneur makes the notification of withdrawal by the consumer electronically possible, he will immediately send a confirmation of receipt after receipt of this notification.
  2. The entrepreneur will reimburse 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 him of the withdrawal. Unless the entrepreneur offers to collect the product himself, he may wait with paying back until he has received the product or until the consumer demonstrates that he has returned the product, whichever is the earlier.
  3. The entrepreneur uses the same payment method that the consumer used for reimbursement, unless the consumer agrees to a different method. The reimbursement is free of charge for the consumer.
  4. If the consumer has opted for a more expensive method of delivery than the cheapest standard delivery, the entrepreneur does not have to pay back the additional costs for the more expensive method.
ARTICLE 11 - 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, at least in time for the conclusion of the agreement:

  1. Products or services whose price depends on fluctuations in the financial market outside the trader's control, which may occur within the withdrawal period;
  2. Agreements concluded during a public auction. A public auction is understood to mean a sales method in which products, digital content and / or services are offered by the entrepreneur to the consumer who is personally present or is given the opportunity to be personally present at the auction, under the direction of an auctioneer, successful bidder is obliged to purchase the products, digital content and / or services;
  3. Service contracts, after full performance of the service, but only if:
  4. the performance has begun with the express prior consent of the consumer; and
  5. the consumer has stated that he will lose his right of withdrawal as soon as the entrepreneur has fully performed the agreement;
  6. Service contracts for provision of accommodation, as the agreement provides for a specific date or period of performance and other than for residential purpose, transport of goods, car rental services and catering;
  7. Agreements with regard to leisure activities, if a specific date or period of execution is provided for in the agreement;
  8. According to specifications of the products manufactured consumer, not prefabricated and manufactured on the basis of an individual choice or decision by the consumer or clearly intended for a specific person;
  9. Products that spoil quickly or have a limited shelf life;
  10. Sealed products that are not suitable for return for reasons of health protection or hygiene and of which the seal has been broken after delivery;
  11. Products that, by their nature, are irrevocably mixed with other products after delivery;
  12. Alcoholic drinks, the price of which was agreed upon at the conclusion of the agreement, but the delivery of which can only take place after 14 days, and the actual value of which depends on fluctuations in the market over which the entrepreneur has no influence;
  13. Sealed audio, video recordings and computer software, the seal of which has been broken after delivery;
  14. Newspapers, magazines or magazines, with the exception of subscriptions to these;
  15. A guarantee provided by the entrepreneur, manufacturer or importer does not affect the legal rights and claims that the consumer can assert against the entrepreneur on the basis of the agreement.
  16. the performance has begun with the express prior consent of the consumer; and
  17. the consumer has stated that he thereby loses his right of withdrawal.
ARTICLE 12 - GIFT CARDS AND VOUCHERS

The following conditions apply to all Mosaique A La Maison gift cards and vouchers.

  1. Vouchers are only valid within the period determined at the time of issue. It is not possible to extend this.
  2. Vouchers cannot be applied to shipping costs or costs for building products.
  3. If the price of your order is higher than the credit of your voucher, you can offset the difference with the payment method offered.
  4. Mosaique A La Maison reserves the right to only accept one voucher per order.
  5. Lost or stolen vouchers are also non-refundable. Mosaique A La Maison is not liable for the loss of vouchers.
  6. Mosaique A La Maison reserves the right to refer to alternative payment methods in accordance with Article 11.1, to refuse delivery and / or to block customer accounts if there is suspicion of misuse in connection with the use of vouchers.

The following additional terms and conditions apply to all vouchers, except paid gift cards.

  1. Vouchers are non-transferable.
  2. Vouchers can be linked to a minimum order value. For administrative reasons, it is not possible to refund or credit the remaining balance that arises if the value of the purchase is below the value of the voucher.
  3. Vouchers will not be refunded if you return all or part of the products or if the products are only partially delivered.
  4. Vouchers may be limited to individual products, in which case they are not transferable to other products.
ARTICLE 13 - THE PRICE
  1. During the period of validity stated in the offer, the prices of the products and / or services offered will not be increased, except for price changes as a result of 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, at variable prices. This link to fluctuations and the fact that any stated prices are target prices are stated in the offer.
  3. Price increases within 3 months after the conclusion of the agreement are only permitted if they are the result of 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:
  5. they are the result of statutory regulations or provisions; or
  6. the consumer has the authority to cancel the contract on the day on which the price increase takes effect.
  7. The prices stated in the offer of products or services include VAT.
ARTICLE 14 - PERFORMANCE OF THE AGREEMENT AND EXTRA WARRANTY
  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 legal provisions existing on the date of the conclusion of the agreement and / or government regulations. If agreed, the entrepreneur also guarantees that the product is suitable for other than normal use.
  2. An extra guarantee provided by the entrepreneur, his supplier, manufacturer or importer never limits the legal rights and claims that the consumer can assert against the entrepreneur on the basis of the agreement if the entrepreneur has failed to fulfill his part of the agreement.
  3. An additional guarantee is understood to mean any obligation of the entrepreneur, his supplier, importer or producer in which he grants the consumer certain rights or claims that go beyond what he is legally obliged to do in case he has failed to fulfill his part of the agreement .
ARTICLE 15 - DELIVERY AND PERFORMANCE
  1. The entrepreneur will take the greatest possible care when receiving and implementing orders for products and when assessing applications 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 what is stated 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 a different delivery period has been agreed. If the delivery is delayed, or if an order cannot or only partially be executed, the consumer will be notified of this no later than 30 days after placing the order. In that case, the consumer has the right to terminate the agreement without costs and is entitled to any compensation.
  4. After dissolution in accordance with the previous paragraph, the entrepreneur will immediately repay the amount paid by the consumer.
  5. The risk of damage and / or loss of products rests with the entrepreneur until the moment of delivery to the consumer or a representative designated in advance and announced to the entrepreneur, unless expressly agreed otherwise.
ARTICLE 16 - DURATION TRANSACTIONS: DURATION, CANCELLATION AND RENEWAL

Termination

  1. The consumer can terminate an agreement that has been entered into for an indefinite period and that extends to the regular delivery of services, at any time with due observance of the agreed cancellation rules and a notice period of no more than one month.
  2. The consumer can terminate an agreement that has been entered into for a definite period and which extends to the regular delivery of services, at any time by the end of the specified period, with due observance of the agreed cancellation rules and a notice period of one month at most.
  3. The consumer can the agreements mentioned in the previous paragraphs:
    • cancel at any time and not be limited to cancellation at a specific time or in a specific period;
    • at least cancel in the same way as they entered into by him;
    • always cancel with the same notice period as the entrepreneur has stipulated for himself.

Renewal

  1. An agreement that has been entered into for a definite period and that extends to the regular delivery of services may not be tacitly renewed or renewed for a fixed term.
  2. Contrary to the previous paragraph, a contract that has been entered into for a definite period and that extends to the regular delivery of daily news and weekly newspapers and magazines may be tacitly renewed for a fixed period of a maximum of three months, if the consumer opposes this extended agreement. can cancel the end of the extension with a notice period of no more than one month.
  3. A contract that has been entered into for a definite period and that extends to the regular delivery of services may only be tacitly renewed for an indefinite period if the consumer may cancel at any time with a notice period of no more than one month and a notice period of no more than 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. Contracts with a limited duration for the regular delivery of daily, news and weekly newspapers and magazines (trial or introductory subscription) will not be tacitly continued and will end automatically after the trial or introductory period.

Duration

  1. If an agreement has a duration of more than one year, the consumer may cancel the agreement at any time after one year with a notice period of no more than one month, unless reasonableness and fairness oppose termination before the end of the agreed term.
ARTICLE 17 - PAYMENT
  1. Unless otherwise specified in the agreement or additional conditions, the amounts owed by the consumer must be paid within 14 days after the start of the cooling-off period, or in the absence of a cooling-off 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 confirmation of the agreement.
  2. When selling products to consumers, the consumer may never be obliged in general terms and conditions to pay more than 50% in advance. When advance payment has been stipulated, the consumer cannot assert any rights whatsoever regarding the execution of the 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 his payment obligation (s) on time, after he has been informed by the entrepreneur of the late payment and the entrepreneur has granted the consumer a period of 14 days to still fulfill his payment obligations, after the non-payment within this 14-day period, the statutory interest is due on the amount due and the entrepreneur is entitled to charge the extrajudicial collection costs incurred by him. These collection costs amount to a maximum of: 15% on outstanding amounts up to € 2,500; 10% over the next € 2,500 and 5% over the next € 5,000 with a minimum of € 40. The entrepreneur can deviate from the stated amounts and percentages in favor of the consumer.
ARTICLE 18 - COMPLAINTS PROCEDURE
  1. The entrepreneur has a well-publicized complaints procedure and handles the complaint in accordance with this complaints procedure.
  2. Complaints about the implementation of the agreement must be submitted fully and clearly described to the entrepreneur within a reasonable time after the consumer has discovered the defects.
  3. Complaints submitted to the entrepreneur will be answered within a period of 14 days from the date of receipt. As a complaint a foreseeable longer processing time
  4. The consumer must in any case give the entrepreneur 4 weeks to resolve the complaint in mutual consultation. After this period, a dispute arises that is subject to the dispute settlement.
ARTICLE 19 - ADDITIONAL OR DIFFERENT PROVISIONS
  1. Additional provisions or provisions deviating 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 they can be stored by the consumer in an accessible manner on a durable data carrier.
ARTICLE 20 - DATA SECURITY
  1. During your registration on mosaiquealamaison.nl you will be asked to transfer personal data. These are data that Mosaiquealamaiso needs to conclude the transactions made on mosaiquealamaison.nl.All personal data is treated confidentially by Mosaique A La Maison and is in accordance with the relevant legal provisions, in particular those of the Basic Data Protection Regulation. (EU-DSGVO) and the Federal Data Protection Act (BDSG). To protect your data during online payment transactions, Mosaique A La Maison uses advanced encryption techniques, such as the Secure Socket Layer (SSL). SSL is a recognized standard protocol that ensures secure data exchange. All data you use to order is encrypted and sent to Mosaique A La Maison.
Annex I: Model form for withdrawal

Model withdrawal form
(only complete and return this form if you wish to cancel the contract)

  • On:
    Mosaique A La Maison
    Europa-Allee 7b
    60327 Frankfurt am Main
    Duitsland
    (no return address)

  • customerservice@mosaiquealamaison.com

  • I / We * share / share * hereby inform you that I / we * our agreement concerning the sale of the following products: [product description] * the supply of the following digital content: [indication digital content] * the performance of the next service: [service indication] *, revoked / revoked *
  • Ordered on * / received on * [date of order for services or receipt for products]
  • [Name of consumer (s)]
  • [Address of consumer (s)]
  • [Signature of consumer (s)] (only if this form is submitted on paper)

* Delete what does not apply or fill in what applies.

Effective: January 2021

Mosaique A La Maison