TERMS AND CONDITIONS OF THE ARTFOX.PL ONLINE STORE
TABLE OF CONTENTS:
1. GENERAL PROVISIONS
2. ELECTRONIC SERVICES IN THE ONLINE STORE
3. CONDITIONS FOR CONCLUDING THE SALES CONTRACT
4. METHODS AND DEADLINES FOR PAYMENT FOR THE PRODUCT
5. COST, METHODS AND DEADLINE FOR DELIVERY OF THE PRODUCT
6. PRODUCT COMPLAINTS
7. EXTRAJUDICIAL METHODS OF EXAMINING COMPLAINTS AND INVESTIGATING CLAIMS AND RULES ACCESS TO THESE PROCEDURES
8. RIGHT OF WITHDRAWAL FROM THE CONTRACT
9. PROVISIONS ON ENTREPRENEURS
10 FINAL PROVISIONS
11. TEMPLATE FOR WITHDRAWAL FROM THE CONTRACT
The Online Store www.artfox.pl cares for the rights of consumers. The consumer may not waive the rights conferred on him in Act on Consumer Rights. Contract terms less favorable to the consumer than the provisions The Consumer Rights Acts are invalid and the provisions of the Consumer Rights Act apply in their place. Therefore, the provisions of these Regulations are not intended to exclude or limit any rights consumers entitled to them under mandatory provisions of law, and all any doubts should be explained in favor of the consumer. In case of any incompatibility provisions of these Regulations with the above provisions, priority is given to these provisions and should be given used.
1. GENERAL PROVISIONS
Online Store available at www.artfox.pl run is entered by Katarzyna Brodowska under the name Artfox Pracownia Złotnicza to the Central Register and Information on Economic Activity of the Republic of Poland kept by minister competent for the economy, having: the address of the place of business and the address to deliveries: ul. Dworcowa 19, 70-206 Szczecin, NIP 852-238-77-69, REGON 321588329, e-mail address: sklep@artfox.pl, phone number: +48 91 4341327
These Regulations are addressed to both consumers, and to entrepreneurs using the Online Store, unless a given provision of the Regulations provides otherwise and is directed exclusively to consumers or traders.
The administrator of personal data processed in the Online Store in connection with the implementation of the provisions of these Regulations is the Seller. Personal data is processed for purposes within the scope and based on the basis and rules indicated in the privacy policy published on the Online Store website. privacy policy primarily contains rules regarding the processing of personal data by the Administrator in the Store Online, including the basics, purposes and scope of personal data processing and the rights of persons, data subjects, as well as information on the use of files in the Online Store cookies and analytical tools. Using the Online Store, including making purchases voluntary. Similarly related to the provision of personal data by using the Online Store The Service Recipient or Customer is voluntary, subject to the exceptions indicated in the privacy policy (conclusion of the contract and statutory obligations of the Seller).
Definitions:
WORKING DAY - one day from Monday to Friday, excluding public holidays.
REGISTRATION FORM - the form is available in Online Store for creating an Account.
ORDER FORM - Service Electronic, interactive form available in the Online Store enabling placing an Order, in particular by adding Products to the electronic basket and specifying the terms of the Sales Agreement, including the method of delivery and payment.
CUSTOMER, CONSUMER- (1) natural person having full legal capacity, and in the cases provided for by the law generally also a natural person with limited legal capacity; (2) legal entity; or (3) an organizational unit without legal personality, which the law confers legal capacity; - who has concluded or intends to conclude a Sales Agreement with the Seller.
CIVIL CODE - Civil Code Act of April 23, 1964 (Journal of Laws 1964 No. 16, item 93, as amended).
ACCOUNT - Electronic service, marked individual name (login) and password provided by the Service User a collection of resources in the system ICT Service Provider, in which data provided by the Customer and information about Orders placed by him in the Online Store.
NEWSLETTER - Electronic Service, electronic distribution service provided by the Service Provider via e-mail, which enables all recipients using it to automatically receive from the Service Provider cyclical content of subsequent editions of the newsletter containing information about Products, new products and promotions in Online Store.
PRODUCT - available in the Online Store a movable item being the subject of a Sales Agreement between the Customer and the Seller.
REGULATIONS - these Regulations of the Store Internet.
ONLINE STORE - the Service Provider's online store available at the Internet address: www.artfox.pl.
SELLER; SERVICE PROVIDER - Katarzyna Brodowska running a business under the name Artfox Workshop entered in the Central Register and Information on the Economic Activity of the Republic of Poland kept by the minister competent for matters economy, having: address of place of business and address for service: ul. Dworcowa 19, 70-206 Szczecin, NIP 852-238-77-69, REGON 321588329, e-mail address: sklep@artfo.pl, phone number: +48 91 4341327.
SALES AGREEMENT - Product sales agreement concluded or concluded between the Customer and the Seller via the Online Store.
ELECTRONIC SERVICE - a service provided by the road electronic by the Service Provider to the Service User via the Online Store.
SERVICE RECIPIENT - (1) a natural person possessing full legal capacity, and in the cases provided for by generally applicable provisions also a natural person with limited legal capacity; (2) legal entity; or (3) unit organizational entity without legal personality, which the law confers legal capacity; - using or intending to use the Electronic Service.
CONSUMER RIGHTS ACT, ACT - act from on May 30, 2014 on consumer rights (Journal of Laws of 2014, item 827, as amended)
ORDER - Customer's declaration of will submitted via the Order Form and aimed directly at the conclusion of the Product Sales Agreement with the Seller.
2. ELECTRONIC SERVICES IN THE ONLINE STORE
The following Electronic Services are available in the Online Store: Account, Order Form and Newsletter.
Account - using the Account is possible after the Customer completing a total of two subsequent steps - (1) completing the Form Registration, (2) clicking the "Register Account" field. In the registration form it is necessary providing the following data by the Service Recipient: login, first and last name / company name, address (street, house / flat number, zip code, city, country), e-mail address, telephone number contact and password. In the case of Customers who are not consumers, it is also necessary to provide company name and tax identification number.
An Electronic Account service is provided free of charge for an indefinite period. The customer has the option, at any time and without giving a reason, deleting the Account (resignation from the Account) by sending a relevant request to the Service Provider, in particular via e-mail to the following address: sklep@artfox.pl or in writing to the following address: ul. Dworcowa 19, 70-206 Szczecin
Order Form - use The Order Form begins when the Customer adds the first Product to electronic basket in the Online Store. Placing an Order takes place after execution by the Customer a total of two subsequent steps - (1) after completing the Order Form and (2) clicking on the Online Store website after completing the Order Form field "I order from obligation to pay "- up to this point you can modify yourself data (for this purpose, follow the displayed messages and information available on the Store's website Internet). The Customer must provide the following information in the Order Form regarding the customer: name and surname / company name, address (street, house / flat number, zip code, place, country), e-mail address, contact phone number and data regarding the Agreement Sales: Product (s), quantity of Product (s), place and method of delivery of the Product (s), payment method. For customers who are not consumers, it is also necessary to provide the name company and tax identification number.
Electronic Service The Order Form is provided free of charge and has a one-off nature and is terminated with when the Order is placed through it or at the time of early termination Orders via the Service Recipient.
Newsletter - using the Newsletter takes place after providing the name and in the "Newsletter" tab of the Online Store e-mail address to which subsequent editions of the Newsletter are to be sent and clicking the field "Sign up". You can also subscribe to the Newsletter by selecting the appropriate one checkbox during account creation - upon creating the Account, the Service Recipient is registered on Newsletter.
Electronic Service The newsletter is provided free of charge for an indefinite period. The customer has the option, at any time and without giving a reason, unsubscribing from the Newsletter (unsubscribing from the Newsletter) by sending an appropriate requests to the Service Provider, in particular via e-mail to the following address: sklep@artfox.pl or in writing to the following address: ul. Dworcowa 19, 70-206 Szczecin.
Technical requirements necessary to work with the system ICT used by the Service Provider: (1) computer, laptop or other device multimedia with Internet access; (2) access to electronic mail; (3) web browser: Mozilla Firefox version 17.0 and higher or Internet Explorer version 10.0 and higher, Opera version 12.0 and higher, Google Chrome version 23.0. and higher, Safari version 5.0 and higher, Microsoft Edge version 25.10586.0.0 and higher; (4) enabling the option of saving Cookies in the web browser Javascript support.
The Service Recipient is obliged to use the Online Store in a manner consistent with the law and decency while respecting personal rights and rights copyright and intellectual property of the Service Provider and third parties. The recipient is obliged to entering data consistent with the facts. The Service Recipient is prohibited from providing content about unlawful nature.
Complaint procedure:
Complaints related to the provision of Services Electronic by the Service Provider and other complaints related to the operation of the Online Store (with excluding the Product complaint procedure, which was indicated in point 6 of the Regulations) The Customer may for example:
- in writing to the address: ul. Dworcowa 19, 70-206 Szczecin;
- in electronic form via mail via e-mail to the following address: sklep@artfox.pl;
It is recommended that the Service Recipient provide in the description Complaints: (1) information and circumstances regarding the subject of the complaint, in particular the type and dates of irregularities; (2) the Customer's requests; and (3) contact details of the applicant complaint - it will facilitate and accelerate the consideration of complaints by the Service Provider. The requirements given in the sentence the previous ones take the form of only recommendations and do not affect the effectiveness of complaints submitted without recommended complaint description.
Response to the complaint by the Service Provider takes place immediately, not later than within 14 calendar days from the date of its submission.
3. CONDITIONS FOR CONCLUDING THE SALES CONTRACT
The conclusion of the Sales Agreement between the Customer and the Seller takes place after prior placement of the Order by the Customer using the Order Form in the Online Store in accordance with point 2. Regulations.
The Product price shown on the Online Store website is given in Polish zlotys and includes taxes. About the total price including taxes of the Product being the subject Orders, as well as delivery costs (including charges for transport, delivery and postal services) and about other costs, and when it is not possible to determine the amount of these fees - about the obligation to pay them, the Customer is informed on the Online Store website when placing the Order, including at the time the Customer wishes to be bound by the Sales Agreement.
The procedure for concluding a Sales Agreement in the Online Store using Order Form
Conclusion of a Sales Agreement between the Customer and The Seller takes place after the Customer has placed an Order in the Online Store in accordance with point 2 of the Regulations.
After placing the Order, the Seller immediately confirms its receipt and simultaneously accepts the Order for execution. Confirmation of receipt of the Order and its acceptance for implementation occurs by sending by Seller to the Customer an appropriate e-mail to the e-mail address provided when placing the Order electronic Customer, which contains at least the Seller's statement of receipt of the Order and about its acceptance for implementation and confirmation of the conclusion of the Sales Agreement. Upon receipt by the customer of the above e-mail, a Sales Agreement is concluded between the Customer and the Seller.
Consolidation, protection and making available to the Customer the content contained The Sales Agreement is made by (1) making these Regulations available on the Online Store website and (2) sending the Customer an e-mail message referred to in point 3. Regulations. Content of the Sales Agreement is additionally recorded and secured in the IT system of the Seller's Online Store.
4. METHODS AND DEADLINES FOR PAYMENT FOR THE PRODUCT
The Seller provides the Customer with the following methods of payment under the Agreement Sales:
- Payment in cash on delivery on delivery Shipping.
- Payment by bank transfer to the Seller's bank account.
- Electronic payments and card payments payment through payu.pl and paypal
- Payment on delivery at the Studio in Szczecin
Payment deadline:
If the Customer chooses to pay by bank transfer, electronic payments or payments by credit card, the Customer is obliged to make payments in within 7 calendar days from the date of the Sale Agreement.
If the customer chooses payment in cash on delivery on delivery, the customer is obliged to make the payment on delivery shipments.
5. COST, METHODS AND DEADLINE FOR DELIVERY AND RECEIPT OF THE PRODUCT
Product delivery is available on the territory of the Member States of the Union European Union. Orders are sent only by Polish Post
Delivery of the Product to the Customer is payable, unless the Sales Agreement provides otherwise. Product delivery costs (including charges for transport, delivery and postal services) are indicated The Customer on the Online Store's website in the information tab regarding delivery costs and in while placing the Order, including when the Customer wishes to be bound by the Contract Sale.
The Seller provides the Customer with the following methods of delivery of the Product: Postal delivery, cash on delivery
The Product delivery time to the Customer is up to 14 Business Days. The beginning of the Product delivery period to The customer counts as follows:
If the customer chooses the payment method by bank transfer, electronic payment or payment card - from the date of crediting the bank account or invoice billing Seller.
If the customer chooses the payment method cash on delivery - from the date of the Sale Agreement.
Changes and corrections made by the customer may affect the extension of the lead time, especially for color or type of stones, size adjustments, etc.
6. PRODUCT COMPLAINTS
The basis and extent of the Seller's liability to the Customer, if the product sold has a physical or legal defect (warranty) are defined by generally applicable regulations law, in particular in the Civil Code (in particular in Articles 556-576 of the Civil Code).
The Seller is obliged to provide the Customer with a Product without defects. Complaint may be submitted by the Customer, for example:
- in writing to the address: ul. Dworcowa 19, 70-206 Szczecin
- in electronic form via mail via e-mail to the following address: sklep@artfox.pl;
It is recommended that the Customer provide (1) information and information in the complaint description circumstances regarding the subject of the complaint, in particular the type and date of the defect; (2) demanding how to bring the Product into compliance with the Sales Agreement or a price reduction statement, or withdrawal from the Sales Agreement; and (3) contact details of the complainant - this will facilitate and will speed up the processing of the complaint by the Seller. The requirements given in the previous sentence have the form only recommendations and do not affect the effectiveness of complaints submitted without the recommended description of the complaint.
The Seller will respond to the Customer's complaint immediately, no later than 14 calendar days from the date of its submission. If the customer is a consumer demanded replacement of the item or removal of the defect, or submitted a price reduction statement specifying the amount, which price is to be reduced and the Seller did not respond to this request within 14 days calendar, it is considered that the request was justified.
The customer who exercises the rights under the warranty is obliged deliver the defective product to the following address: ul. . Dworcowa 19, 70-206 Szczecin. In the case of an existing customer the cost of delivery of the Product to the consumer shall be borne by the Seller, in the case of a Customer who is not a consumer the cost delivery is borne by the customer.
7 . EXTRAJUDICIAL METHODS OF EXAMINING COMPLAINTS AND PURSUING CLAIMS AND RULES OF ACCESS TO THOSE PROCEDURES
Detailed information about the possibilities of using by A customer who is a consumer with out-of-court complaint and redress methods, and rules for access to these procedures are available on the Office of Competition Protection's website Consumers at: https://uokik.gov.pl/pozasadowe_rozwiazywanie_sporow_konsumenckich.php.
There is also a point next to the President of the Office for Competition and Consumer Protection contact (phone: 22 55 60 333, email: kontakt.adr@uokik.gov.pl or in writing: Powstańców Square Warszawy 1, 00-030 Warsaw.), Whose task is, among others, to provide assistance to consumers in matters relating to the out-of-court resolution of consumer disputes.
The consumer has the following examples of the possibilities of using out-of-court complaint consideration and redress: (1) application for settlement a dispute to a permanent amicable consumer court (more information at: http://www.spsk.wiih.org.pl/); (2) a request for out-of-court resolution of the dispute to the voivodeship inspector of the Trade Inspection (more information on the site of the inspector competent for the place of business by the Seller); and (3) assistance of a poviat (municipal) consumer ombudsman or organization social, whose statutory tasks include consumer protection (including the Federation Consumers, Association of Polish Consumers). Advice is provided, among others, by email at adress@dlakonsumentow.pl and under the helpline number 801 440 220 (helpline open on Days Working, from 8:00 to 18:00, connection fee according to the operator's tariff).
A platform is available at http://ec.europa.eu/consumers/odr online dispute resolution between consumers and businesses at EU level (ODR platform). The ODR platform is an interactive and multilingual website with a comprehensive point services for consumers and entrepreneurs seeking out-of-court settlement of a dispute regarding contractual obligations under an online sales contract or contract for the provision of services (more information on the platform's website or at the Office of Competition Protection's website Consumers: https://uokik.gov.pl/spory_konsumenckie_faq_platforma_odr.php).
8. RIGHT OF WITHDRAWAL FROM THE CONTRACT
A consumer who has a distance contract may within 14 days withdraw from it without giving a reason and without incurring costs, except for costs specified in point 8 of the Regulations. To meet the deadline, it is enough to send a statement before his expiration. A declaration of withdrawal may be made, for example:
- in writing to the address: ul. . Dworcowa 19, 70-206 Szczecin;
- electronic form via electronic mail to the following address: sklep@artfox.pl;
An example of a withdrawal form is provided in pt. 11 of the Regulations and on the Online Store website in the tab regarding withdrawal from the contract. The consumer can use the form template, but it is not mandatory.
The deadline to withdraw from the contract begins:
for the contract performed by the Seller releases the Product, being obliged to transfer its ownership (e.g. Sales Agreement) - from taking up Product in possession by the consumer or a third party designated by him other than the carrier, and in the case of a contract that: (1) includes many Products that are delivered separately, in batches or in parts - from taking possession of the last Product, batch or part or (2) relies on regular delivering Products for a fixed period - from taking possession of the first of Products;
for other contracts - from the date of conclusion agreement.
In the event of withdrawal from a distance contract, the contract is considered to be void.
The seller is obliged to immediately, not later than within 14 calendar days from the date of receipt of the consumer's statement on withdrawal from the contract, return the consumer for all payments made by him.
The consumer is obliged to immediately, not later than within 14 calendar days from the day on which he withdrew from the contract, return the Product to the Seller. To keep the date is enough to return the Product before its expiry. The consumer may return the Product to the following address: ul. . Dworcowa 19, 70-206 Szczecin. Consumers send goods for exchange / return at their own expense. For shipping the goods from the exchange are again payable by the Consumer (i.e. PLN 15). The package should be accompanied by a purchase document, and information about what exchange we have to make or completed withdrawal form. The store doesn't accepts no parcels sent COD.
The consumer is responsible for reducing the value of the Product being the result of using it in a way that goes beyond what is necessary to establish the nature, characteristics and the functioning of the Product.
W in the case of a Product which is a service which, at the express request of the consumer, has begun before the deadline to withdraw from the contract, the consumer who exercises the right to withdraw from the contract after submitting such a request, he is obliged to pay for the services fulfilled until the withdrawal from the contract. The amount payments are calculated in proportion to the scope of the service rendered, including those agreed in the contract prices or remuneration. If the price or remuneration is excessive, the basis for calculating this amount is the value market performance.
No right to withdraw from a distance contract the consumer in respect of contracts:
(1) for the provision of services if the Seller has performed in performs the service with the express consent of the consumer who was informed before the start of the service that after the Seller fulfills the service, he will lose the right to withdraw from the contract; (2) in which the price or the remuneration depends on fluctuations in the financial market over which the Seller has no control, and which may occur before the deadline to withdraw from the contract; (3) in which the subject provision is a non-prefabricated product, manufactured according to the consumer's specification or serving satisfying his individual needs; (4) in which the subject of the service is the Product quickly deteriorating or having a short shelf life; (5) in which the subject of the service is the Product delivered in a sealed package, which when opened the packaging cannot be returned due to health protection or hygiene reasons, if the packaging was opened after delivery; (6) in which the subject of the service are Products, which after delivery, due to their nature, are inseparably connected with others things; (7) in which the subject of the service are alcoholic beverages the price of which has been agreed upon conclusion of the Sales Agreement, which may only be delivered after 30 days and whose value depends on market fluctuations over which the Seller has no control; (8) in which the consumer expressly demanded that the Seller come to him for urgent repairs or maintenance; if the Seller provides additional services other than those demanded by the consumer, or provides Products other than spare parts necessary to carry out repair or maintenance, law the consumer is entitled to withdraw from the contract in relation to additional services or Products; (9) in the object of which are sound or visual recordings or computer programs delivered in sealed packaging, if the packaging has been opened after delivery; (10) for delivery newspapers, periodicals or magazines, with the exception of subscription contracts; (11) concluded on the way public auction; (12) for the provision of accommodation services other than for residential purposes, transport of things, car rental, gastronomy, leisure services, events entertainment, sports or cultural, if the contract indicates the day or period of service provision; (13) Fr. providing digital content that is not recorded on a tangible medium if fulfilling benefits began with the express consent of the consumer before the deadline to withdraw from the contract and after the Seller informing him about the loss of the right to withdraw from the contract.
9. PROVISIONS ON ENTREPRENEURS
This section of the Regulations and the provisions contained herein relate to only Customers and Service Users who are not consumers.
The Seller has the right to withdraw from the Sales Agreement concluded with A customer who is not a consumer within 14 calendar days from the date of its conclusion. Withdrawal from the Agreement The sale in this case may take place without giving a reason and does not give rise to a non-client the consumer no claims against the Seller.
In the case of customers who are not consumers, the Seller has the right limit the available payment methods, including requiring prepayment in whole or in part and that regardless of the payment method chosen by the Customer and the fact of concluding the Sales Agreement.
Upon the release of the Product by the Seller, the carrier shall pass to Non-consumer customer benefits and burdens associated with the Product and the risk of accidental Product loss or damage. In this case, the seller is not responsible for loss, loss or damage to the Product arising from its acceptance for transport until its release to the Customer and for delay in delivery shipment.
If the Product is sent to the Customer via the carrier, the Customer who is not a consumer is obliged to examine the parcel in time and in the manner adopted for parcels this kind. If it finds that during transport there was a loss or damage to the Product, it is obliged to take all steps necessary to determine the liability of the carrier.
According to art. 558 $ 1 of the Civil Code, liability of the Seller with the title of warranty for the Product to a Customer who is not a consumer is excluded.
In the case of Customers who are not consumers, the Service Provider may terminate the contract for the provision of Electronic Services with immediate effect and without indicating the reasons by sending the Customer a relevant statement.
Liability of the Service Provider / Seller in relation to the Service Recipient / Customer non-consumer, regardless of its legal basis, is limited - both within single claim, as well as for all claims in total - up to the price paid and delivery costs under the Sales Agreement, but not more than up to the amount of one thousand zlotys. The Service Provider / Seller is liable to the Service Recipient / Customer who is not a consumer only for typical damage foreseeable at the time the contract is concluded and is not liable for loss benefits to the Service Recipient / Customer who is not a consumer.
Any disputes arising between the Seller / Service Provider and The Customer / Service Recipient who is not a consumer shall be subject to the court with jurisdiction over the registered office Sellers / Service Providers.
10. FINAL PROVISIONS
Agreements concluded through the Online Store are concluded in Polish.
Amendments to the Regulations:
The Service Provider reserves the right to make changes to the Regulations for important reasons, that is: changes in law; changes in payment methods and deliveries - to the extent that these changes affect the implementation of the provisions of these Regulations.
If concluded on the basis of this Regulations of continuous contracts (e.g. provision of Electronic Services - Account) amended the regulations are binding on the Service Recipient, if the requirements specified in art. 384 and 384 [1] of the Code civil, i.e. the Customer has been properly notified of the changes and has not terminated the contract within 14 days calendar days from the date of notification. In the event that a change to the Regulations results in an introduction any new fees or increase of the existing Customer who is a consumer has the right to withdraw from agreement.
If concluded on the basis of this Of the Regulations of contracts of a different nature than continuous contracts (e.g. Sales Agreement), changes to the Regulations will not be in in no way violate the acquired rights of Customers / Customers who are consumers before on the day of entry into force of amendments to the Regulations, in particular amendments to the Regulations will not affect anymore placed or placed Orders and concluded, implemented or executed Sales Agreements.
In matters not covered by these Regulations shall apply generally applicable provisions of Polish law, in particular: the Civil Code; Act on providing services by electronic means of July 18, 2002 (Journal of Laws 2002 No. 144, item 1204, as amended); for Sales contracts concluded until December 24, 2014 with customers who are consumers - the provisions of the Act on protection of certain consumer rights and liability for damage caused by a product Dangerous of March 2, 2000 (Journal of Laws 2000 No. 22, item 271 as amended) and the Special Act terms of consumer sales and the amendment to the Civil Code of July 27, 2002 (Journal of Laws 2002 No. 141, Pos. 1176, as amended); for Sales Agreements concluded from December 25, 2014 with customers who are consumers - provisions of the Act on consumer rights of 30 May 2014 (Journal of Laws of 2014, item 827, as amended); and other relevant provisions of applicable law.
11. MODEL WITHDRAWAL FROM THE CONTRACT FORM
Model withdrawal form
(this form should be completed and returned only if you wish to withdraw from the contract)
- Recipient:
Artfox Goldsmith Workshop, Katarzyna Brodowska
Ul. Dworcowa 19
70-206 Szczecin
- I / We (*) hereby I inform / inform (*) about my / our withdrawal from the sales contract of the following items (*) of the delivery contract the following items (*) for a specific work contract involving the following items (*) / for a benefit the following service (*)
- Date of conclusion of the contract (*) / receipt (*)
- order number
- Name of consumer (s)
- Consumer (s) address
- bank account number for a refund
- Signature of the consumer (s) (only if the form is sent in paper version)
- Date
(*) Delete where not applicable.