Withdrawal form

 
Addressee: C Plussz Vision Ltd.
(Address: 55 Árpád Street Budapest 1042, e-mail: hello@lovetheorganic.com
 
The Undersigned hereby declare that we are practicing our right to withdraw from the
purchase of the following product(s) or the services to be given within the contract:
…………………………………………………………………………………………………
……………………………………………………………………………
Date of Contract of Service/ Reception of the product:
…………………………………………………………
Customer(s) name:
…………………………………………………………………………………
Customer(s) address:
…………………………………………………………………………………
I would like to have the purchase price transferred back to the following bank account: (fill in
if you would like us to repay you via bank transfer):
…………………………………………………………………………………………………
…………………………………………………………………
Customer(s) Signatures (only in case of withdrawal form declared on paper)
…………………………………………………………………………………
 
Date: