WITHDRAWAL FORM FROM THE SALES CONTRACT
WITHDRAWAL FORM FROM THE SALES CONTRACT
(Template compliant with consumer rights regulations) Date: ............................................................ Consumer Details: Full Name: ..................................................................................... Address: ............................................................................................ Phone Number: ................................................................................ E-mail: ..............................................................................................
Declaration of withdrawal from the contract
I, the undersigned, hereby notify you of my withdrawal from the sales contract concerning the following product(s): 1. .............................................................................................. 2. .............................................................................................. 3. .............................................................................................. Date of receipt of the goods: .................................................... Order / Invoice Number: ..........................................................
Refund details
Please issue the refund to the following bank account: Bank Account Number: ........................................................................ Account Holder's Name (if different from the purchaser): .................................................................................................................... (If the payment was made by card, the refund will be issued to the bank account associated with that card unless otherwise specified.)
Consumer's Signature .................................................................................. (Consumer's signature – only if this form is submitted in paper form.)
J&M POLAND SP. Z.O.O
Marka produktów MASILIC
Ul. Puławska 479
02-844 Warszawa
NIP: 7011290778
Dane kontaktowe:
Phone: +48 534 442 969
Mail: masilic@vercalio.pl