Withdrawal from the contract

WITHDRAWAL FROM THE PURCHASE AGREEMENT

Buyer:

Name und Surname      ………………………………………………………………………………….

Address                       ………………………………………………………………………………….

Telephone                   …………………………………………………………………………………

E-mail                         …………………………………………………………………………………

Seller:

VAPE spol. s r.o.

 Bílanska 1647/34a, 767 01 Kromeriz, Czech Republic

Identification number:  00543551

Registered in the Commercial Register kept by the Regional Court in Brno, Section C, Insert 1911

Telefon           +420 573 308 132, +420 573 308 141

E-mail             vape@vape.cz

Please send the withdrawal form to the address:

VAPE spol. s r.o., Bilanska 1647/34a, Kromeriz, Czech Republic

or e-mail address: vape@vape.cz

I hereby announce to withdraw from the Purchase Agreement in full extent; I return all the items mentioned on the invoice: YES/NO* (delete where necessary)

* (YES = do not fill the particular item; NO = fill the item you want to return)

Item number / pcs        ………………………………………………………………………………

Invoice number:           ………………………………………………………………………………

Order number                ………………………………………………………………………………      

Order date                   ……………………………………………………………………………….     

Please refund the paid amount to account no. ..…………………………………………………….

Or another way            …………………………………………………………………………….

Date                                        ………………………………………………………

Customer signature                  ………………………………………………………

The signature is necessary only if the form is printed out.