Statement of withdrawal from Sales Agreement

Statement of withdrawal from the Sales Agreement

	___________________, ________________ r.
	(place and date)
The Buyer
__________________________ (name and surname)
__________________________ (street, hous no., flat no.)
__________________________ (post code, city)

		Store Pan Trójniak Wilków 69 24-313 Wilków Poland

STATEMENT OF WITHDRAWAL FROM THE SALES AGREEMENT

I, the undersigned, declare that I withdraw from the agreement for the sale of the following Goods:

________________________________________________________________________________

________________________________________________________________________________.

Order data:

– number of Order: _________________________________________________________________________

– date of placing the Order (day/month/year): ____________________________________________________

– date of delivery the Goods: (day/month/year): _______________________________________

PKD codes of the Buyer’s business activity (enter only if the Buyer is an Entrepreneur with Consumer rights):

________________________________________________________________________________

____________________________________ (legible signature of the Buyer)