Terms and Conditions of The Aquarian Alchemist Online Store

§ 1 Definitions

The terms used in these Terms and Conditions shall mean:

  1. Seller – The Aquarian Alchemist Sp. z o.o. with its registered office in Osowiec (96-321) at ul. Sosnowa 6, Poland, entered into the Register of Entrepreneurs of the National Court Register kept by the District Court for Łódź-Śródmieście in Łódź, 20th Commercial Division of the National Court Register, under KRS number: 0001172255, NIP (Tax Identification No.): PL5291861553, REGON (National Business Registry No.): 541702507, e-mail address: hi@theaquarianalchemist.com, tel.: +48 22 390 5886.
  2. Online Store – the online service run by the Seller at the address http://theaquarianalchemist.com, through which the Customer can place Orders.
  3. Customer – a natural person with full legal capacity, and in cases provided for by generally applicable laws, also a natural person with limited legal capacity; a legal person; or an organizational unit without legal personality, to which the law grants legal capacity – who concludes or intends to conclude a Sales Agreement with the Seller or uses Electronic Services.
  4. Consumer – a Customer who is a natural person concluding a legal transaction with the Seller (e.g., concluding a sales agreement) not directly related to their business or professional activity.
  5. Entrepreneur with consumer rights – a Customer who is a natural person concluding an agreement directly related to their business activity, when it is apparent from the content of this agreement that it is not of a professional nature for this person, arising in particular from the subject of their business activity, made available on the basis of provisions on the Central Register and Information on Economic Activity (CEIDG). [Note: This is a concept specific to Polish law. Its applicability and the extent of rights for such entrepreneurs may vary in other EU countries. The core EU consumer rights primarily apply to “Consumers” as defined in point 4.]
  6. Product / Goods – a movable item available in the Online Store which is the subject of a Sales Agreement between the Customer and the Seller.
  7. Sales Agreement – a sales agreement for a Product concluded or to be concluded between the Customer and the Seller via the Online Store.
  8. Electronic Service – a service provided electronically by the Seller to the Customer via the Online Store, e.g., Customer Account, Order Form, Newsletter.
  9. Customer Account (Account) – an Electronic Service, a collection of resources in the Seller’s IT system, identified by an individual name (login) and password provided by the Customer, in which the Customer’s data and information about their Orders in the Online Store are stored.
  10. Order Form – an Electronic Service, an interactive form available in the Online Store enabling the placement of an Order, in particular by adding Products to the electronic shopping cart and specifying the terms of the Sales Agreement, including the method of delivery and payment.
  11. Order – a declaration of will by the Customer submitted via the Order Form and aimed directly at concluding a Sales Agreement for a Product with the Seller.
  12. Terms and Conditions – these terms and conditions of the Online Store.
  13. GDPR – Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation).
  14. Working Day – one day from Monday to Friday, excluding public holidays.

§ 2 General Provisions

  1. These Terms and Conditions define the rules for using the Online Store, including the rules for concluding Sales Agreements and providing Electronic Services.
  2. To use the Online Store, including browsing the assortment and placing orders for Products, the following are necessary:
    a. an end device (e.g., computer, tablet, smartphone) with Internet access and a web browser such as Mozilla Firefox, Google Chrome, Microsoft Edge, Opera, Safari;
    b. an active e-mail account;
    c. enabled cookies in the web browser.
  3. The Customer is obliged to use the Online Store in a manner consistent with the law and good customs, respecting the personal rights and copyrights and intellectual property of the Seller and third parties. The Customer is prohibited from providing unlawful content.
  4. To the fullest extent permitted by law, the Seller shall not be liable for any disruptions, including interruptions in the functioning of the Online Store, caused by force majeure, unlawful actions of third parties, or incompatibility of the Online Store with the Customer’s technical infrastructure.
  5. Browsing the Online Store’s assortment does not require creating an Account. Placing orders by the Customer for Products in the Online Store’s assortment is possible either after creating an Account in accordance with § 3 of these Terms and Conditions or by providing the necessary personal and address data enabling the execution of the Order without creating an Account.
  6. These Terms and Conditions are made available free of charge before concluding an agreement on the Online Store’s website in a form that allows them to be downloaded, saved, and printed. The Customer is obliged to read these Terms and Conditions before placing an Order.

§ 3 Electronic Services in the Online Store

  1. The following Electronic Services are available in the Online Store: Customer Account, Order Form, and Newsletter (if the Seller offers such a service and the Customer consents to it).
  2. Customer Account:
    a. Using the Account is possible after the Customer completes two consecutive steps: (1) filling out the registration form, (2) clicking the “Register” field (or equivalent). The registration form requires the Customer to provide the indicated data.
    b. The agreement for the provision of the Electronic Service consisting of maintaining a Customer Account is concluded for an indefinite period and is free of charge.
    c. The Customer may, at any time and without giving a reason, delete the Account (resign from the Account) by sending an appropriate request to the Seller, in particular via e-mail to: hi@theaquarianalchemist.com or in writing to the Seller’s address.
  3. Order Form:
    a. Using the Order Form begins when the Customer adds the first Product to the electronic shopping cart in the Online Store.
    b. Placing an Order occurs after the Customer completes two consecutive steps: (1) filling out the Order Form and (2) clicking the “Order and pay” field (or equivalent) on the Online Store’s website after filling out the Order Form – until this moment, it is possible to independently modify the entered data. The Order Form requires the Customer to provide the data indicated as mandatory.
    c. The Electronic Service Order Form is provided free of charge, is of a one-off nature, and ends when the Order is placed through it or when the Customer ceases to place an Order through it earlier.
  4. Newsletter: (if applicable)
    a. Using the Newsletter occurs after providing the e-mail address in the “Newsletter” tab visible on the Online Store’s website to which subsequent editions of the Newsletter are to be sent and clicking the action field, or by checking the appropriate checkbox when creating an Account or placing an Order.
    b. The Electronic Service Newsletter is provided free of charge for an indefinite period. The Customer may, at any time and without giving a reason, unsubscribe from the Newsletter (resign from the Newsletter) by sending an appropriate request to the Seller, in particular via e-mail to: hi@theaquarianalchemist.com or by clicking the appropriate deactivation link in each Newsletter message.
  5. Complaint procedure for Electronic Services:
    a. Complaints related to the provision of Electronic Services by the Seller and other complaints related to the operation of the Online Store may be submitted by the Customer, for example: in writing to the Seller’s registered office address or electronically via e-mail to: hi@theaquarianalchemist.com.
    b. It is recommended that the Customer provide in the complaint description: (1) information and circumstances regarding the subject of the complaint, in particular the type and date of occurrence of the irregularity; (2) the Customer’s request; and (3) contact details of the complainant – this will facilitate and expedite the Seller’s consideration of the complaint.
    c. The Seller will consider the complaint promptly, no later than within 14 calendar days from the date of its submission.

§ 4 Conditions for Concluding a Sales Agreement

  1. Announcements, advertisements, price lists, and other information about Products provided on the Online Store’s websites, in particular their descriptions, technical and functional parameters, and prices, constitute an invitation to conclude an agreement within the meaning of Article 71 of the Polish Civil Code. [Note: This reference is to Polish law; the principle is generally understood in contract law.]
  2. The price of the Product displayed on the Online Store’s website is given in EUR (or the currency clearly indicated during the ordering process) and includes all components, including VAT. However, prices do not include possible delivery and payment costs, which are indicated to the Customer on the Online Store’s pages during the ordering process, including immediately before and at the time of confirming and placing the Order.
  3. The total value of the Order, including the price of the Product, delivery costs (if any), and any other costs, is always indicated to the Customer in the order summary before it is placed.
  4. Procedure for placing an Order in the Online Store using the Order Form:
    a. The Customer completes the Order by selecting the Product(s) they are interested in by clicking the “Add to cart” button (or equivalent).
    b. After completing the entire Order and indicating the delivery method and payment form in the “Cart,” the Customer places the Order by sending the Order form to the Seller by clicking the “Order and pay” field (or equivalent) on the Online Store’s website.
    c. Before placing the Order, the Customer is obliged to read these Terms and Conditions and the Privacy Policy and accept their provisions by checking the appropriate box (checkbox). Consenting to marketing is voluntary.
    d. Placing an Order constitutes a declaration of will by the Customer expressing a direct intention to conclude a distance Sales Agreement with the Seller via the Online Store.
    e. After placing the Order, the Seller immediately confirms its receipt, which binds the Customer to their declaration, and simultaneously accepts the Order for execution. Confirmation of receipt of the Order and its acceptance for execution occurs when the Seller sends the Customer an appropriate e-mail message to the e-mail address provided by the Customer during the ordering process. This message contains at least the Seller’s declarations of receipt of the Order and its acceptance for execution, as well as confirmation of the conclusion of the Sales Agreement.
    f. Upon receipt by the Customer of the above e-mail message, a Sales Agreement is concluded between the Customer and the Seller.
  5. The content of the concluded Sales Agreement is recorded, secured, and made available to the Customer by (1) making these Terms and Conditions available on the Online Store’s website and (2) sending the Customer the e-mail message referred to in section 4(e) above. The content of the Sales Agreement is additionally recorded and secured in the Seller’s Online Store IT system.

§ 5 Payment Methods and Terms for the Product

  1. The Seller provides the Customer with the following payment methods for the Sales Agreement:
    a. Electronic payments and card payments via external payment systems, such as:
    * imoje (operated by ING Bank Śląski S.A. with its registered office in Katowice, Poland),
    * Autopay,
    * PayPal,
    * Przelewy24,
    * Stripe.
    b. Payments such as traditional bank transfer, BLIK, Google Pay, Apple Pay may also be supported, depending on the integration with the selected payment gateway.
    c. Detailed information on available payment methods and operators is presented during the ordering process and on the Online Store’s website in the relevant information tab.
  2. The Customer is obliged to make the payment within 3 calendar days from the date of conclusion of the Sales Agreement, unless the chosen payment method (e.g., cash on delivery) indicates otherwise. In the event of non-payment within the specified period, the Seller may withdraw from the Sales Agreement.

§ 6 Cost, Methods, and Term of Product Delivery

  1. Product delivery is available within the territory of the Republic of Poland and to EU countries such as: Germany, Austria, Netherlands, Sweden (or others, if the Seller offers such a possibility – specific countries and costs will be indicated during the ordering process or in a separate shipping policy).
  2. Product delivery to the Customer is subject to a fee, unless the Sales Agreement states otherwise. Product delivery costs (including fees for transport, delivery, and postal services) are indicated to the Customer on the Online Store’s pages during the ordering process, including at the moment the Customer expresses their will to be bound by the Sales Agreement.
  3. The cost of delivery depends on the destination country, delivery method, and order value. For domestic shipments within Poland, delivery via parcel locker typically costs around 12–15 PLN, and via courier approximately 20 PLN, for orders below 250 PLN. Orders over 250 PLN within Poland are eligible for free delivery.
    For deliveries to European Union countries, the standard courier delivery cost is approximately 45–50 PLN per order. Free delivery to EU countries is available for orders exceeding 400 PLN.
    The exact delivery cost is displayed during the ordering process, based on the selected delivery option and destination. Delivery costs currently range from 0 PLN (if free shipping applies) up to a maximum of approximately 50 PLN.
  4. The Seller provides the Customer with the following Product delivery methods:
    a. Courier shipment (e.g., InPost, BLPaczka, Furgonetka, or other international couriers).
    b. Parcel locker shipment (e.g., InPost Parcel Lockers or similar services available in the destination country).
  5. The Product delivery term to the Customer is usually 1-3 Working Days for deliveries within Poland, and may be longer for other EU countries (estimated delivery times will be provided during the ordering process), unless a shorter or longer term is specified in the Product description or during the ordering process. For Products with different delivery terms, the longest given term applies. The Product delivery term to the Customer begins as follows:
    a. If the Customer chooses payment by bank transfer, electronic payment, or payment card – from the date the Seller’s bank account or settlement account is credited.
    b. If the Customer chooses payment on delivery – from the date of conclusion of the Sales Agreement.

§ 7 Right of Withdrawal from the Agreement
(Applies to Consumers and Entrepreneurs with consumer rights)

  1. A Consumer and an Entrepreneur with consumer rights who has concluded a distance contract may withdraw from it within 14 calendar days without giving any reason and without incurring costs, except for the costs specified in section 7 below.
  2. To meet the withdrawal deadline, it is sufficient to send the Seller a statement of withdrawal before its expiry. The statement of withdrawal may be submitted, for example:
    a. in writing to the address: The Aquarian Alchemist Sp. z o.o., ul. Sosnowa 6, 96-321 Osowiec, Poland;
    b. electronically via e-mail to: hi@theaquarianalchemist.com.
  3. An exemplary withdrawal form template is provided in Annex 1 to these Terms and Conditions. The Consumer / Entrepreneur with consumer rights may use the template form, but it is not obligatory.
  4. The withdrawal period begins:
    a. for an agreement in the performance of which the Seller hands over the Product, being obliged to transfer its ownership – from the moment the Consumer / Entrepreneur with consumer rights or a third party indicated by them, other than the carrier, takes possession of the Product;
    b. for other agreements – from the date of conclusion of the agreement.
  5. In the event of withdrawal from a distance contract, the contract is considered not concluded.
  6. The Seller is obliged to immediately, no later than within 14 calendar days from the date of receipt of the Consumer’s / Entrepreneur’s with consumer rights statement of withdrawal, reimburse all payments made by them, including the costs of delivering the Product (except for additional costs resulting from the Customer’s chosen delivery method other than the cheapest standard delivery method offered in the Online Store). The Seller will reimburse the payment using the same payment method used by the Consumer / Entrepreneur with consumer rights, unless they have expressly agreed to a different reimbursement method that does not involve any costs for them. If the Seller has not offered to collect the Product themselves, they may withhold reimbursement of payments received from the Consumer / Entrepreneur with consumer rights until they have received the Product back or until proof of its return has been supplied, whichever event occurs first.
  7. The Consumer / Entrepreneur with consumer rights is obliged to immediately, no later than within 14 calendar days from the date on which they withdrew from the agreement, return the Product to the Seller or hand it over to a person authorized by the Seller to collect it, unless the Seller has offered to collect the Product themselves. To meet the deadline, it is sufficient to send back the Product before its expiry.
  8. The Consumer / Entrepreneur with consumer rights bears the direct costs of returning the Product.
  9. The Consumer / Entrepreneur with consumer rights is liable for any diminished value of the Product resulting from handling it in a way other than what is necessary to establish the nature, characteristics, and functioning of the Product.
  10. The right of withdrawal from a distance contract does not apply to a Consumer / Entrepreneur with consumer rights in respect of contracts specified in Article 38 of the Polish Act of 30 May 2014 on Consumer Rights (implementing the EU Consumer Rights Directive), e.g., contracts for goods made to the consumer’s specifications or clearly personalized; contracts for goods supplied in a sealed package which are not suitable for return due to health protection or hygiene reasons and were unsealed after delivery.

§ 8 Product Complaint (Liability for Defects / Lack of Conformity)

  1. The Seller is obliged to deliver to the Customer a Product that conforms with the contract. The Seller is liable to the Customer who is a Consumer or an Entrepreneur with consumer rights for any lack of conformity of the Goods with the sales agreement existing at the time of delivery and which becomes apparent within two years from that time (legal guarantee), unless the usability period of the Goods, as specified by the Seller, its legal predecessors, or persons acting on their behalf, is longer.
  2. The basis and scope of the Seller’s liability to the Customer, if the sold Product has a physical or legal defect (under Polish law, “rękojmia”), or lacks conformity, are defined by generally applicable laws, in particular the Polish Civil Code and the Polish Act on Consumer Rights (which implement relevant EU Directives, such as the Sale of Goods Directive).
  3. A complaint may be submitted by the Customer, for example:
    a. in writing to the address: The Aquarian Alchemist Sp. z o.o., ul. Sosnowa 6, 96-321 Osowiec, Poland;
    b. electronically via e-mail to: hi@theaquarianalchemist.com.
  4. It is recommended that the Customer provide in the complaint description: (1) information and circumstances regarding the subject of the complaint, in particular the type and date of occurrence of the defect/lack of conformity; (2) a request for how to bring the Product into conformity with the Sales Agreement (repair or replacement) or a statement on price reduction or withdrawal from the Sales Agreement (in cases specified by law); and (3) contact details of the complainant – this will facilitate and expedite the Seller’s consideration of the complaint. The requirements stated in the preceding sentence are only recommendations and do not affect the effectiveness of complaints submitted without the recommended description.
  5. The Seller will respond to the Customer’s complaint promptly, no later than within 14 calendar days from the date of its submission. Failure by the Seller to respond within this period means that the Seller has deemed the complaint justified (this applies to a request for replacement, removal of a defect, or a statement on price reduction made by a Consumer or an Entrepreneur with consumer rights).
  6. If, for the Seller to respond to the Customer’s complaint or for the Customer to exercise their rights resulting from the legal guarantee, it is necessary to deliver the Product to the Seller, the Customer will be asked by the Seller to deliver the Product at the Seller’s expense to the indicated address. A request to deliver the Product does not affect the deadline for the Seller to respond to the Customer’s complaint.
  7. The Seller’s liability under the legal guarantee (rękojmia) towards Customers who are neither Consumers nor Entrepreneurs with consumer rights is excluded, unless mandatory provisions of law state otherwise.

§ 9 Additional 365-day Satisfaction Guarantee

  1. Regardless of the rights arising from the legal guarantee and the statutory right of withdrawal, the Seller offers Customers an additional, voluntary satisfaction guarantee for 365 days from the date of receipt of the Product.
  2. Under this guarantee, if the Customer is not satisfied with the Product, they may return it by sending a notification to the e-mail address: hi@theaquarianalchemist.com, stating the reason for the return.
  3. The condition for using the satisfaction guarantee is returning the Product (in as intact condition as possible, in the original packaging if possible) to the Seller’s address. The cost of return shipping under this guarantee is borne by the Customer.
  4. After receiving the returned Product and positively considering the notification, the Seller will refund the Customer the price of the Product within 14 calendar days.
  5. This satisfaction guarantee does not exclude, limit, or suspend the Customer’s rights arising from the provisions on liability for defects of the sold item (legal guarantee) or the statutory right of withdrawal.

§ 10 Liability for Transport Damage

  1. The Seller is liable to the Customer who is a Consumer or an Entrepreneur with consumer rights for the conformity of the Goods with the contract, including for any damage occurring during transport until the Goods are delivered to the Customer.
  2. To facilitate and expedite a possible complaint process regarding transport damage, it is recommended that the Customer (especially a Consumer or an Entrepreneur with consumer rights) check the condition of the shipment in the presence of the courier immediately upon delivery. If any damage to the packaging or Product is found, it is recommended to draw up an appropriate damage report in the presence of the courier and immediately inform the Seller.
  3. Failure by a Consumer or an Entrepreneur with consumer rights to follow the above recommendation does not affect their rights under the legal guarantee or commercial guarantee, nor the Seller’s liability for transport damage.
  4. In the case of Customers who are neither Consumers nor Entrepreneurs with consumer rights, upon the Seller’s release of the Product to the carrier, the benefits and burdens associated with the Product, as well as the risk of accidental loss or damage to the Product, pass to the Customer. In such a case, the Seller is not liable for any loss, defect, or damage to the Product occurring from its acceptance for transport until its delivery to the Customer, nor for any delay in the transport of the shipment.

§ 11 Out-of-Court Complaint and Redress Mechanisms (ADR/ODR)

  1. A Customer who is a Consumer has the option of using out-of-court complaint and redress mechanisms. Detailed information on the possibility for a Consumer to use out-of-court complaint and redress mechanisms and the rules of access to these procedures are available at the registered offices and on the websites of district (municipal) consumer ombudsmen, social organizations whose statutory tasks include consumer protection, Voivodeship Inspectorates of Trade Inspection, and at the following internet addresses of the Office of Competition and Consumer Protection (UOKiK – Polish authority):
    1. https://www.uokik.gov.pl/pozasadowe_rozwiazywanie_sporow_konsumenckich.php
    1. https://www.uokik.gov.pl/sprawy_indywidualne.php
    1. https://www.uokik.gov.pl/wazne_adresy.php
      [Note: The above links refer to a Polish authority and may be less relevant for non-Polish consumers. The EU ODR platform below is key for all EU consumers.]
  2. A Customer who is a Consumer also has the option of using the online dispute resolution (ODR) platform in accordance with Regulation (EU) No 524/2013 of the European Parliament and of the Council of 21 May 2013 on online dispute resolution for consumer disputes. The ODR platform is available at: http://ec.europa.eu/consumers/odr/. Using the ODR platform is voluntary.
  3. The above provisions are for informational purposes and do not constitute an obligation for the Seller to use out-of-court dispute resolution methods, unless such an obligation arises from legal provisions or the Seller expresses consent below. The Seller informs that it agrees to participate in proceedings concerning out-of-court resolution of consumer disputes.

§ 12 Personal Data Protection

  1. The Seller is the controller of Customers’ personal data collected via the Online Store.
  2. Customers’ personal data collected by the controller via the Online Store are collected for the purposes specified in the Privacy Policy.
  3. Detailed information regarding the processing of personal data and Customers’ rights can be found in the Privacy Policy available on the Online Store’s website.

§ 13 Intellectual Property

  1. All content posted on the Online Store’s website, including Product names, trademarks, logos, photos, and descriptions, are protected by copyright and are the property of the Seller or entities with whom the Seller has concluded relevant agreements.
  2. Any use of this content without the prior written consent of the Seller is prohibited.

§ 14 Final Provisions

  1. Agreements concluded through the Online Store are made in the language of these Terms and Conditions (English) and are governed by Polish law. [Important Note for EU Consumers: While Polish law may be chosen as the governing law of the contract, consumers residing in other EU countries are additionally protected by the mandatory provisions of consumer law of their country of habitual residence if the Seller directs its activities to that country. This means that if a provision of Polish law is less favorable to the consumer than a mandatory provision of their own national law, the latter will prevail.]
  2. The Seller reserves the right to amend these Terms and Conditions for important reasons, i.e.: changes in legal provisions; changes in payment and delivery methods; changes in the scope, fees, or form of Electronic Services provided – to the extent that these changes affect the implementation of the provisions of these Terms and Conditions.
  3. The Seller will inform the Customer of any changes at least 14 days in advance by publishing them on the Online Store’s website and, in the case of Customers with an Account, by sending information to the e-mail address assigned to the Account.
  4. In the case of continuous agreements concluded on the basis of these Terms and Conditions (e.g., provision of the Electronic Service – Account), the amended terms and conditions bind the Customer if the requirements specified in Article 384 and 384¹ of the Polish Civil Code have been met, i.e., the Customer has been duly notified of the changes and has not terminated the agreement within 14 calendar days from the notification. If a change in the Terms and Conditions results in the introduction of any new fees or an increase in current ones, a Customer who is a consumer has the right to withdraw from the agreement.
  5. In the case of agreements of a nature other than continuous agreements concluded on the basis of these Terms and Conditions (e.g., Sales Agreement), amendments to the Terms and Conditions will not in any way infringe the acquired rights of Customers who are consumers before the effective date of the amendments, in particular, amendments to the Terms and Conditions will not affect Orders already being placed or placed, nor concluded, executed, or performed Sales Agreements.
  6. In matters not regulated by these Terms and Conditions, generally applicable provisions of Polish law shall apply, in particular: the Polish Civil Code; the Polish Act on Rendering Electronic Services; the Polish Act on Consumer Rights; the Polish Act on Personal Data Protection. [Note: And relevant EU regulations where directly applicable.]
  7. Any disputes arising from agreements concluded with the Seller shall be resolved primarily amicably. In the absence of an amicable solution:
    a. the court competent to resolve disputes arising from agreements concluded with Customers who are neither Consumers nor Entrepreneurs with consumer rights is the court competent for the Seller’s registered office.
    b. in the case of disputes with Consumers and Entrepreneurs with consumer rights, the competent court is determined according to generally applicable provisions of Polish law (which, for consumers in the EU, typically means they can bring claims before the courts of their country of residence). [Important Note for EU Consumers: Consumers residing in the EU generally have the right to bring proceedings against the Seller either in the courts of the Member State in which the Seller is domiciled or in the courts of the Member State in which the consumer is domiciled.]
  8. These Terms and Conditions shall enter into force on 01/06/2025.


Annex 1 to the Terms and Conditions of The Aquarian Alchemist Online Store – Model Withdrawal Form
(This form should only be completed and returned if you wish to withdraw from the contract)

To:
The Aquarian Alchemist Sp. z o.o.
ul. Sosnowa 6, 96-321 Osowiec, Poland
E-mail: hi@theaquarianalchemist.com

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

Date of contract()/receipt(): …………………………………………………………………………………………….

Name of consumer(s) / entrepreneur(s) with consumer rights:
…………………………………………………………………………………………………………………………………………………………

Address of consumer(s) / entrepreneur(s) with consumer rights:
…………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………

Order number (if known): …………………………………………………………………………………………….

Bank account number for reimbursement (if payment was not made electronically or if the Customer wishes reimbursement to a different account):
…………………………………………………………………………………………………………………………………………………………

Signature of consumer(s) / entrepreneur(s) with consumer rights (only if this form is notified on paper):
…………………………………………………………………………………………………………………………………………………………

Date: ……………………………………………………..

(*) Delete as appropriate.