Sample withdrawal form

SAMPLE WITHDRAWAL FORM
for Consumers and Entrepreneurs with consumer rights

NOTE: Please complete and return this form only if you wish to withdraw from the contract

………………………., ……………………………….

…………………………………………
(Customer’s full name)
………………………………………..
…………………………………………
(Customer’s correspondence address)
…………………………………………
(Customer’s phone number / email)

Casual Authentic - Maciej Twardziński
Modzelewskiego 23/330
02-679 Warsaw
kontakt@casualauthentic.com

WITHDRAWAL FROM DISTANCE CONTRACT

I hereby inform you of my withdrawal from the sales contract for the following goods: ………………………………………………

Date of contract …………………………………………

Date of receipt of goods …………………………………………………..

I declare that I will return the goods without delay and no later than within fourteen days. Below I provide the bank details for the refund of the product price, which should be made without delay and no later than within fourteen days: ……………………………………..……

 

 

……………………………………………………
(Customer’s name, surname and signature if the form is sent in paper version)