Model withdrawal form

Fill it in on screen and save it as a PDF, or print it and fill it in by hand. Rules: Returns.

Model withdrawal form — Annex I(B) to Directive 2011/83/EU (Annex 2 to the Polish Consumer Rights Act of 30 May 2014)

Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

To — the seller

Qindito Sp. z o.o., ul. Tytusa Chałubińskiego 8, 00-613 Warszawa

e-mail: sklep@qindito.pl

Address for returning the parts

ul. Południowa 15, 97-310 Michałów

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*):

No.	Part name	Part number (e.g. P-004604)
1
2
3

Order number

Ordered on

Received on

Name of consumer(s)

Address of consumer(s)

E-mail or phone — for contact about the return

Account number for the refund — if different from the one used for payment

Reason for return — optional, helps us improve our offer

Date

Signature of consumer(s) — only if this form is notified on paper

(*) Delete as appropriate.

How to return a part: send the form by e-mail or enclose it with the parcel. Return the part within 14 days of withdrawing from the contract to the return address given above, quoting the order number. Pack it securely; secure components containing operating fluids against leakage. The direct cost of return is borne by the buyer. The refund will be made within 14 days of receipt of the statement, to the account from which the payment was made.