↓ Store address (from invoice):

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STATEMENT OF CANCELLATION OF CONTRACT

for the consumer

Departed from the contract of sale of the following things:

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Concluded on .......................... order number .......................... date of receipt............................

Please refund .................. zł/EUR (in writing...........................................................................)

By postal mail to: ....................................................., or

The bank account number: ..................................................................……………………………

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full name

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address

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city, date

signature of the consumer