Order Number: ........................................................................................................ First and Last Name: ............................................................................................................. Address: .............................................................................................................................. ......................................................................................................................................... Phone Number: ...........................................................................................................................
Please refund the money to the bank account: Account No.
Product Name: Quantity: Gross Price:
Customer Remarks: ...............................................................................................................…..........................................................................................................................................……..………………………………………………………....................................................................................................................................................................................................................……...………………………………………………………..………………………..………………………..……
I declare that I am aware of the return conditions specified in the Store Regulations.
.................................................. (Customer's signature)
.................................................. (podpis Klienta).