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Statement of withdrawal example

Statement of withdrawal example

(This form must be completed and returned just in case you wish to withdraw from the agreement)

- Recipient:
Regess sp. z o.o.
Bankowa 36, 58-500 Jelenia Góra
tel: +48 501922954

- I hereby inform about withdrawal from purchase agreement goods:

...............................................................................................

...............................................................................................

- Purchase date:

...............................................................................................

- Name and surname:

...............................................................................................

- Adress:

...............................................................................................

- Signature:............................................
(only if the form is sent on paper)


- Date: ............................

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