(complete and return this form only if you wish to withdraw from the contract)
Klub Fundacji Centaurus, with its registered office in Wrocław, ul. Skarbowców 23A/BUD.B3, 53-025 Wrocław, entered in the register of associations, other social and professional organisations, foundations and independent public healthcare institutions (also entered in the register of entrepreneurs) kept by the District Court in Wrocław, 6th Commercial Division of the National Court Register under KRS 0000278299, REGON 140974200, NIP 8943068607
e-mail: shop@goodvia.org
I/We(*) hereby give notice that I/We(*) withdraw from my/our contract of sale of the following goods(*)
- Order number: _______________
- Account / invoice number: _______________
- Date of conclusion of the contract(*) / of receipt(*): _______________
- Name of consumer(s): _______________
- Address of consumer(s): _______________
- Signature of consumer(s) (only if this form is notified on paper)
- Please reimburse the amount to bank account no.: _______________
(*) Delete as appropriate.
