Form for withdrawal from contract

Form for withdrawal from contract

name of seller: MUSICA GIOIA

name of seller: MUSICA GIOIA
main office: Pertoldova 3327/23, Praha 12 – Modřany
company registration number (CRN): 00712728 
internet website of e-shop: www.musicagioia.cz 
e-mail address of seller: info@musicagioia.cz 
telephone number of seller: +420 603 714 241 
…………………………………………………………………………………………………………………………………….

(fill in below, please)

I am announcing that I withdraw from the contract in lawful term of 14 days:
number of order:
number of tax document:
name and code of the goods:
date of ordering the goods (making the sale contract):
date of receiving the goods:
name and surname of purchaser:
permanent address:e-mail address:
contact telephone number:
the way of payment done:
The way I ask to reimburse the sale price: (here write the account number for reimbursement)

reason of withdrawal: (optional)

place……………………………date……….

………………………………………………………..
signature (in case posting in printed form)