Cancellation Form

Cancellation Form

(Please fill in and submit this form only if you wish to cancel the contract. The form must be printed, signed, scanned and sent to the email address provided below, or attached to the return slip.)

Recipient: Store: Address: Registered office: Value Added Tax: Email address: Email address: Phone number:

I hereby cancel the purchase contract for the following item .............. / for the provision of the following service ..........................

Order date ........................ / Date of receipt ........................... Order number:

The payment for the order, and any delivery charges, was made in the following way: ................. and will be refunded in the following way: ................................ (in case of bank transfer, please provide your account number)

Consumer's name and surname: Consumer's address: Email: Consumer's name and surname: Consumer's address: Phone: Consumer: Name and surname

In ..................., on ............................

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Consumer's name and surname