STATEMENT REGARDING WITHDRAWAL FROM REMOTE AGREEMENT
between
Bizuteka.pl Magdalena Makowska
ul. Słowackiego 12/21
01-627 Warszawa
tel. +48 604 654 235
e-mail: shop@bizuteka.pl
and
___________________
__________________
___________________
(data of the customer)
Pursuant to § 7, section 1 of the act of 2nd March 2000 on the protection of certain customer rights and on the liability for damage caused by dangerous products (consolidated text: Journal of Laws of 2012, item 1225), I hereby announce that I withdraw from the remote agreement I concluded via www.bizuteka.pl online shop ran by Magdalena Makowska residing in Warszawa 01-627, at ul. Słowackiego 12/21 with regard to the following goods constituting the subject matter of order number __________________________ or receipt/invoice number _______________________ and which were delivered to me on* _______________________:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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*Providing this data will make return process easier and faster.
I enclose the above-indicated goods in an unchanged condition.
Please reimburse me for their purchase price by transferring it:
– to the account of the credit card which was used to finalise the payment,
or
– to account number:
____________________
(date, signature)