Contract Withdrawal Form

              Contract Withdrawal Form

according to § 7 et seq. Act No. 102/2014 Coll. on consumer protection
Buyer/Consumer
Name and surname*:
Street and number*:
The city*:
Zip code*:
E-mail*:
Telephone:
I hereby inform you that I withdraw from the concluded purchase contract for this product (name
product): [1]
I am requesting a refund* of the full invoice value (all invoiced goods)
partial value of the invoice (only a certain part of the goods)
Order date*:
Order number*:
Delivery date (day of collection)*:
Invoice number*:
Account number (if you wish to return the money by bank transfer to your account) or address (if you
you wish to return the money by mail) for the return of payments related to the conclusion of the purchase contract*:
I am obliged to send the goods to the seller no later than 14 days from the day of withdrawal.
Signature of the consumer/consumers* (only if this form is submitted in paper form)
On _______________ day:_______________
* Marked fields are mandatory

 

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