Contract withdrawal form.
(To be completed only in case of an intention to withdraw from a contract with the Seller).
Addressee (Company): Relab Corp Sp. z o.o., ul. Hanasiewicza 19, 35-103 Rzeszów, Polska.
Consumer’s first name and surname: ………………………………………………………………………..
Consumer’s Address:…………………………………………………………………………………………….
Contact information (email/phone number)…………………………………………………………………..
Withdrawal declaration
I hereby inform you of withdrawal from the contract/order whose subject is…………………………. …………………………………………………………………………………………………………………………
Order date: ……………………………………………………………………………………………………..……
Sales Document Number (invoice/receipt number): ………………………………………………………..
Order number……………………………………………………………………………………………………….
Bank account number to be refunded* :……………………………………………………………………….
Date:………………………..… Signature: …………………………………
* In the case of a return of funds to a different account than the one from which payment for the Order was made.
