Sample withdrawal statement
Below is a sample statement for withdrawing from a distance contract for a pass purchase. You do not need to state a reason for withdrawal.
Seller details
Oleksandra Tailer-Melyn, conducting business under the firm name Oleksandra Tailer-Melyn, entered in the Central Register and Information on Economic Activity (CEIDG), NIP: 6772533001, REGON: 543183649, under the Bawialnia Kropka brand
Address: ul. Wrocławska 53M lok. LU3, 30-011 Kraków
E-mail: bawialniakropka@gmail.com
Consumer’s full name: …………………………………………
E-mail address: …………………………………………
Consumer’s address (optional): ………………………………………… (optional)
Order number: …………………………………………
Purchased pass name: …………………………………………
Contract date: …………………………………………
Withdrawal statement
I hereby withdraw from the contract for the purchase and use of a Bawialnia Kropka playroom pass, concluded on the date stated above.
Date of this statement: …………………………………………
Signature (for written form): …