Contract withdrawal form

Trwa dodawanie produktów...

 CONTRACT WITHDRAWAL FORM

(the form shall be filled in and sent only when you wish to withdraw from the Contract)

The Recipient: Codeglade sp. z o.o., ul. Wiśniowa 2, 72-010 Police

 

Name and surname of the Consumer(s):

 

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Consumer(s) IBAN bank account number:

 

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Address of the Consumer(s):

 

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________________________________________________________

 

Consumer(s) phone no.:

 

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Consumer(s) e-mail address:

 

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I/we (*) hereby represent that I/we (*) withdraw from the Contract to perform the following service:

 

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Contract order no.:

 

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Date of concluding the Contract:

 

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Date, Signature