Template withdrawal form

What follows is a template withdrawal form from the contract which the Consumer is free to use:

TEMPLATE OF A DECLARATION ON WITHDRAWAL FROM THE CONTRACT
(this form should be filled in and sent only in the event one wishes to withdraw from the Agreement)

–  LOMAN Sp. z o.o., ul. Wapienicka 20, 43-382 Bielsko-Biała, [email protected]

– I/We*) hereby wish to inform you (*) about my/our withdrawal from the agreement on the sale of the following things(*) agreement on the supply of the following things:_____________________________________________________________________________

– Date on which the agreement was concluded(*)/ date of receipt(*):__________________________________________________________________________

– Name and surname of the consumer(s): __________________________________________________________________________________

– Address of the consumer(s):_____________________________________________________________

– Signature of the consumer(s) (only if the declaration is sent in paper form:_____________________________________________________________________________

– Date:_______________________________________________________________________________

(*) Delete as appropriate.