Withdrawal from the Contract Form

Withdrawal from the Contract Form

Please complete and send this form back only if you wish to withdraw from the contract.

Recipient:

Hyalogos s.r.o.
Zimákova 1148/29
E-mail: hyalogos@hyalogos.com
Phone: +420 724 323 599

I hereby give notice that I withdraw from the purchase contract for the following goods:

......................................................................................
......................................................................................

Date of order: ....................................
Date of receipt: ....................................

Name and surname of the consumer: ......................................................
Address of the consumer: .................................................................
E-mail: .............................................................................
Phone: ............................................................................

Order / Invoice number: ........................................................

I am returning the goods (please tick): [ ] by post [ ] in person

Date: .........................................................
Signature of the consumer (only if this form is sent in paper form):
............................................................

In the event of withdrawal from the contract, the amount paid will be refunded using the same payment method as used for the original purchase,
no later than 14 days after the returned goods have been received.