WITHDRAWAL FORM
SAMPLE WITHDRAWAL FORM
(this form should be completed and returned only if you wish to withdraw from the contract)
Bies Albert Korzeń
street Bohaterów Orła Biały 127a, 33-300 Nowy Sącz
e-mail address: info@biesclth.com
- I/We(*) ......................................... ............................ hereby inform(*) about my/our withdrawal from the contract of sale of the following items(*) / for the provision of the following services(*):
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- Date of conclusion of the contract (*) /acceptance (*)
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- Name and surname of the Consumer(s)/Privileged Entrepreneur(s):
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- Address of the Consumer(s)/Privileged Entrepreneur(s):
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Signature of the Consumer(s)/Privileged Entrepreneur(s)
(only if the form is sent in paper version)
Date ............................................
(*) Delete as appropriate.