Complete and return this form only if you wish to withdraw from the contract. Details and deadlines are in the terms of business.
Addressee: David Šmídmajer, Mírová 1013, Prachatice, 38301, Czech Republic, email: shop@saltyroad.cz
I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following goods (*) / for the supply of the following service (*):
Ordered on (*) / received on (*):
Order number and variable symbol:
Name of consumer(s):
Address of consumer(s):
Bank account number for the refund (optional):
Signature of consumer(s) (only if this form is sent on paper):
Date:
(*) Delete as appropriate or fill in.