Withdrawal from Contract Form

(In accordance with Section 1829(1) of Act No. 89/2012 Coll., Civil Code, and Government Regulation No. 363/2013 Coll., on the model instructions on the right of withdrawal from contracts concluded at a distance or outside business premises and the model withdrawal form)

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Addressee:

Company name:
Company ID (IČO):
VAT ID (DIČ):

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I hereby give notice that I withdraw from the contract for the purchase of the following goods:

…………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………….

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Date of purchase:

Order number:

Invoice number:

Full name:

Email address:

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Address:

…………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………….

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The purchase price shall be refunded by bank transfer to the following bank account number:

………………………………………………../……………………………………

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The Buyer shall notify the Company of the withdrawal in writing to the registered address of the Company or electronically to the email address specified in this model form.

If the Buyer who is a consumer withdraws from the purchase contract, the Buyer shall send or hand over to the Company, without undue delay and no later than 14 days from the withdrawal from the purchase contract, the goods received from the Company.

The Company is not obliged to refund the received funds to the Buyer before it has received the goods back or before the Buyer has provided proof that the goods have been sent back to the Company, whichever occurs first.

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Date: …………………..

Signature of the Buyer: ……………………………………………………………