MODEL FORM FOR WITHDRAWAL FROM A DISTANCE CONTRACT AND AN OFF-PRICE CONTRACT
www.wvagon.com
(Please complete and send this form only if you wish to withdraw from a distance contract or an off-premise contract.)
– To: Dávid Lazar, A. Stodolu 162/12, 971 01, Prievidza, Slovak Republic
– I/we hereby give notice* that I/we withdraw* from the contract for the supply or provision of this product: ..............
– Order date/receipt date* ..............
– Name and surname of the consumer/consumers* ..............
– Address of the consumer/consumers* ..............
– Signature of the consumer/consumers* (if this form is submitted in paper form) ..............
– Date ..............
* Delete as appropriate