Consumer withdrawal
Model withdrawal form
Complete and return this form only if you wish to withdraw from the contract. You may send any other unambiguous withdrawal statement instead.
To: Mateusz Sury, ul. Biedronki 8 lok. 2, 52-200 Wysoka, Poland
Email: theteroles@gmail.com
I/We hereby give notice that I/we withdraw from the contract concerning:
- Relay Pass plan: ..........................................................
- Random order reference shown on the receipt: ..............................
- Contract date: ............................................................
- Consumer name: ............................................................
- Consumer address: .........................................................
- Date: .....................................................................
- Signature (paper form only): ..............................................
Do not include a vault password, keys, profile identifier or communication content.