ANNIE-M Piotr Olszowski Zabłocie 35/113, 30-701 Kraków NIP NUMBER 8172101240 REGON NUMBER 388443952
Declaration
of withdrawal from contract concluded outside the seat or at a distance
I/We (*)………………….……………hereby give notice that I/We withdraw from my/our contract of sale of the following items(*) ………………………………..……
contract for the supply of the following items(*) …………………………………………………………..
contract for specific work consisting in the performance of the following items (*) / for the provision of the following service (*) …………………………………………..……………………
Ordered on 1/Received on2(*)………………………………………..……………….
……………………………………
Customer signature(s)
(*) Delete as appropriate
1 provide, if the contract concerned rendering services
2 provide, if the contract concerned the purchase of items
