Annex 1 WITHDRAWAL FORM (the form should be filled in and sent

Annex 1
WITHDRAWAL FORM
(the form should be filled in and sent to the Store only if the Customer/Trader wishes to withdraw
from the agreement)
Wydawnictwo Uniwersytetu Wrocławskiego Sp. z o.o.
plac Uniwersytecki 15
50-137 Wrocław
[email protected]
I, _____________, hereby express my intention to withdraw from the agreement for the delivery of
the following products:__________________________________________________
Date of the agreement/delivery:________________________________
Customer first and last name:__________________________________
Customer address:_____________________________________
Customer signature*:____
*only when the form is to be sent in paper format
Date: ______