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Terms and Conditions

General Commercial Terms and Conditions of the company TEREZIA COMPANY s.r.o. (“Conditions”)

1. Fundamental Provisions

1.1. These General Commercial Terms and Conditions of the company TEREZIA COMPANY s.r.o. with the registered office Na návrší 997/14, 141 00 Praha 4, Identification No. 272 51 659, incorporated in the Commercial Register maintained with the Municipal Court in Prague, File No. C 107724 (“Seller”) stipulate within the meaning of Section 1751(1) of Act No. 89/2012 Coll., Civil Code (“Civil Code”) mutual rights and obligations of the parties established in connection with or on the basis of a purchase agreement concluded between the Seller and a natural person through the Seller´s e-shop www.terezia.eu (“E-shop”).

1.2. The operator and owner of the website www.terezia.eu is the Seller. The Seller is solely entitled to execute all property rights in relation to this website in compliance with Act No. 121/2000 Coll., on Copyright. Any storage, modification and dissemination of this website is subject to the Seller´s exclusive consent.

1.3. Access and use of the website www.terezia.eu is free of charge, the visitor is using the website at his own risk. The Seller shall bear no liability for the safety of the use and interrupted access to this website.

1.4. For communication with the Seller you may use the electronic address: info@terezia.eu

1.5. “Goods” are for the purposes of the Conditions defined as all range of articles and products offered by the Seller within the framework of the E-shop.

1.6. “Purchaser” is for the purposes of the Conditions defined as a natural person who does not act within his business activity or within an individual performance of his profession. The Purchaser is a consumer.

1.7.”Agreement” is for the purposes of the Conditions defined as a purchase agreement concluded between the Purchaser and the Seller through the E-shop for the purpose of transfer of the ownership right to the Goods, performance of the delivery of the Goods and payment for the purchase price of the Goods.

1.8. “Order” is for the purposes of the Conditions defined as an order of the respective Goods performed by the Purchaser through the E-shop.

1.9. “E-mail” is for the purposes of the Conditions defined as the Seller´s mailbox which shall be indicated by the Seller within the framework the Order.

1.10. “Parties” are for the purposes of the Conditions defined as the Seller and the Purchaser.

1.11. The Purchaser agrees to use remote communication means during conclusion of the Agreement. The costs incurred to the Purchaser in using the remote communication means in connection with concluding the Agreement shall be paid by the Purchaser himself (Internet connection, phone calls). The Seller does not conclude through the remote communication means agreements concerned with repeated performance.

 

2. Order and Conclusion of the Agreement

2.1. The precondition for concluding the Agreement is performance of the Order, namely by confirmation of the form intended for performance of the Order by the Purchaser. By performance of the Order the Purchaser declares that

(i) he orders the indicated Goods with the Seller;

(ii) he has fully acquainted himself with these Conditions, he agrees with them and takes them for binding;

(iii) all provisions of the Conditions are clear, comprehensible and readable without specific difficulties or limitations and that they were communicated to him in a comprehensible and clear manner.

2.2. The Order shall be regarded as the Purchaser´s proposal to conclude the Agreement. The Agreement has been concluded at the moment of delivery of the Purchaser´s confirmation of the Order to the Seller, as a consent with the Purchaser´s proposal to conclude the Agreement. The Purchaser declares that by performance of the Order he explicitly agrees with the manner of concluding the Agreement. The Seller shall be obliged to deliver the confirmation of the Order to the Purchaser without undue delay to the Purchaser´s E-mail address, unless stipulated otherwise in these Conditions.

2.3. The Seller reserves the right not to confirm the Order or its part in case the Goods are no more produced, delivered or are already sold out or in case there exists another relevant reason for which it is not possible to fairly require from the Seller a confirmation of the Order, for instance due to infringement of previously concluded Agreements between the Seller and the particular Purchaser.

2.4. Conclusion of the Agreement without stipulating all its prerequisites provided by CC within the meaning of Section 1726 CC is excluded. In compliance with Section 1740(3) of CC the Seller further excludes acceptance of an offer with an amendment or divergence. The Seller reserves the right not to deliver Goods outside the EU countries.

2.5. In case the Seller does not intend to confirm the Order pursuant to the previous point, it shall inform the Purchaser of this fact by an E-mail without undue delay.

2.6. In case the Purchaser has already paid the purchase price for the Goods or its part and the Order has not been confirmed by the Seller, this amount shall be refunded to the Purchaser without undue delay.

2.7. The Seller and the Purchaser confirm in agreement that prior to concluding the Agreement or before the Purchaser made the Order, the Purchaser was informed of the Seller´s identity and contact details, of designation of the Goods, its main characteristics, price of the Goods and delivery means of the Goods.

 

3. Delivery of Goods

3.1. The Seller shall deliver the Goods to the Purchaser´s place of residence indicated in the Order. Within the framework of the order, the Purchaser may indicate a delivery place for the Goods other than that indicated by him as his residence address.

3.2. Unless another deadline is indicated for individual Goods, the usual deadline for delivery of Goods is 15 (fifteen) working days from the conclusion of the Agreement, unless stipulated otherwise in the Conditions, provided that the delivery place is in the territory of the Czech Republic. In individual cases the delivery date may be longer, of which the Purchaser shall be notified upon acceptance of the Order by the Seller or without undue delay after acceptance of the Order.

3.3. In case of choosing the payment of the purchase price for the Goods through non-cash bank transfer, PayPal payment system or on-line payment by payment card, the delivery dates shall commence to run from the day following the day on which the full purchase price for the Goods (including delivery price) was credited to the Seller´s bank account/PayPal.

3.4. The Purchaser has the right to choose the means of delivery of the Goods and the costs for its delivery according to actual offer provided in the E-shop. Delivery of the Goods shall be carried out in the form of personal collection in the Seller´s place of business free of charge or in the form of a local mode of transport, being in the Czech Republic:

a) product Parcel delivery to hand or similar product according to the offer of the company Česká pošta, s.p. and according to the current pricelist of the company Česká pošta, s.p.;

b) product Parcel delivery to post office or similar product according to the offer of the company Česká pošta, s.p.  and according to the current pricelist of the company Česká pošta, s.p.;

c) product Parcel delivery to a subsidiary of the Parcel Pickup Outlet Zásilkovna or similar product and according to current pricelist of the company Zásilkovna s.r.o.;

d) product GLS Parcel Service or similar product according to the offer of the company General Logistics Systems Czech Republic s.r.o. and according to the current pricelist of the company General Logistics Systems Czech Republic s.r.o.

In case of delivery of goods outside the Czech Republic the Goods are sent through Česká pošta and cooperating local carriers according to the place of delivery.

3.5. In case the Seller is under the Agreement obliged to deliver the Goods to a place designated by the Purchaser in the Order, the Purchaser shall be obliged to take over the Goods upon delivery.  Should the Purchaser fail to take over the Goods, the Seller shall be entitled to require from the Purchaser reimbursement of the costs for storage or the Seller shall be entitled to rescind the Agreement. The Seller shall be entitled to set off one-sidedly the reimbursement of the costs  against the Purchaser´s claim for refund of the purchase price in case of the Seller´s rescission of the Agreement.

3.6. Upon takeover of the Goods, the Purchaser is obliged to check the integrity of the packaging and in case of any defects announce this fact immediately to the carrier with whom he shall draft up a report on claims. An incomplete or damaged delivery must be simultaneously announced to the Seller without undue delay. In case of a damaged packaging indicating unlawful intrusion in the delivery the Purchaser is not obliged to take the delivery from the carrier.

3.7. In case that due to reasons attributable to the Purchaser it is necessary to deliver the goods repeatedly or in other way than indicated in the Order, the Purchaser shall be obliged to pay the costs connected with the repeated delivery of the goods or the costs connected with the other way of delivery, as appropriate.

 

4. Purchase Price and Payment Terms

4.1. In case of concluding an Agreement on the purchase of Goods with the purchase price which, after deduction of all discounts and value of used gift vouchers exceeds CZK 1,000 (VAT inclusive), and in case the delivery place of the Goods is in the Czech Republic, the costs for delivery of the Goods shall be paid by the Seller.

4.2. Information about the Goods and the Purchase price indicated by the Seller are binding, excepting obvious errors. The Purchase prices are presented including VAT in the statutory amount, excepting the costs for delivery of the Goods. The Seller may provide the Purchase a discount on the purchase price under the conditions provided in the E-shop.

4.3. Under the Agreement the Purchaser is obliged to pay the Seller the purchase price for the Goods which is indicated for the relevant Goods in the E-shop and take over the Goods.

4.4. Unless provided otherwise in these Conditions, the Purchaser is obliged to pay the costs for delivery of the Goods (see item 3.4.) to the delivery place together with the purchase price.

4.5. Payment of the purchase price for the Goods is possible in one of the following methods:

a) by payment in cash to the Seller (only in case of personal takeover of the Goods);

b) by payment card to the Seller (only in case of personal takeover of the Goods);

c) by payment to the carrier upon delivery and takeover of the Goods (cash on delivery);

d) on-line by payment card;

e) by non-cash bank transfer;

f) through the PayPal payment system.

4.6. In case of payment cash on delivery or in cash the purchase price is due upon takeover of the Goods. In other cases the purchase price of the Goods is due within the deadline of 7 days from conclusion of the Agreement.

 

5. Vouchers

5.1. The Purchaser is entitled to pay the purchase price for the Goods or its part by a gift or discount voucher (hereinafter as “Voucher”). The voucher takes the form of a unique code generated by the Seller or the form of a universal code (hereinafter as “Code”).

5.2. Each unique code may be used only once (1 time). Each universal code may be used even several times until the end of validity of the Voucher.

5.3. The Purchaser shall use the Voucher upon the purchase by entering the Code into the column “Use the Discount Code” and “Verify” in the content summary of the shopping basket. After entering the Code the total nominal value of the applied Vouchers shall be immediately deducted from the total purchase price of the Goods.

5.4. Vouchers with a nominal value may be combined at will. The discount voucher expressed in percentage of the purchase price for the Goods may not be used together with another Discount Voucher expressed in percentage of the purchase price for the Goods. Vouchers with a nominal value may be combined with a discount voucher expressed in percentage of the purchase price of the Goods, the nominal value of the used Voucher to be deducted from the purchase price of the Goods after deduction of the percentage discount.

5.5. Information about the validity period or conditions for using the Voucher is always indicated on the carrier including the Code (i.e. in case of a unique code sent to the Purchaser by e-mail in such e-mail, in case of a universal printed code in a document including such  code). Validity period of the Voucher shall be defined either (a) as a deadline for using the Voucher running from the issue of the Voucher, under issue of the Voucher to be understood the first making accessible the Voucher Code to the person who has acquired the Voucher from the Seller or from a third party with the Seller´s consent or (b) as a final date by which the Voucher may be used. A Voucher that shall not be used by the Purchaser within the time of its validity may not be changed for another one nor is it possible to reimburse it or prolong its validity.

5.6. Should the purchase price of the Goods chosen by the Purchaser be lower than the nominal value of the Voucher, the costs for delivery of the Goods may be covered by the Voucher up to the unused value of the Voucher.

5.7. Should the value of the Voucher be expressed as a percentage discount, it shall be understood that the discount shall be calculated only from the total amount of the purchase price of the Goods (VAT inclusive), i.e. the discount shall not apply to the costs for delivery of the Goods to the Purchaser or for any other costs.

5.8. Should the purchase price of the Goods chosen by the Purchaser exceed the nominal value of the Voucher, the Purchaser shall pay the remaining part of the purchase price in compliance with Article 4 of these Conditions.

5.9. Should the purchase price of the Goods chosen by the Purchaser be lower than the nominal value of the Voucher, by using the Voucher and completing the Order it shall be understood that the validity period of the Voucher in relation to the unused value of the Voucher has ceased and the Purchaser or any third party shall not be entitled to use again the Voucher in the unused value.

 

6. Rescission of the Agreement

6.1. The Purchaser may rescind the Agreement within 14 days from the takeover of the Goods even without giving reason, regardless the manner of takeover of the Goods or making the payment (“Rescission”). In such case he is obliged to return the Goods in an intact condition and free of defects back to the Seller. The Purchaser shall send or hand the Rescission of the Agreement to the Seller within 14 days from takeover of the Goods. The Purchaser is entitled to use for the Rescission a template according to the relevant implementing regulation which he shall find on the Seller´s website and which is provided in the Annex to these Conditions.

6.2. In order to comply with the deadline for the Rescission it is sufficient to send the Rescission to the Seller before expiry of the time limit for the Rescission (see Article 6.1. of the Conditions) in written form to the address of the Seller´s place of business.

6.3. In case of a Rescission the Purchaser is obliged to return or send the Goods to the address TEREZIA COMPANY s.r.o., Na návrší 997/14, 141 00 Prague 4 – Michle, Czech Republic within 14 days from the Rescission. When sending, the Purchaser is obliged to pack the Goods preferably into the original wrapping, otherwise into another appropriate wrapping in order to avoid damage or destruction. It is necessary to annex to the Goods a copy of the delivery note or invoice.  

6.4. In case of a regular Rescission the Seller shall refund the Purchaser the price of the Goods and costs for delivery of the Goods it has received from the Purchaser, no later than within 14 days from the date by which the following conditions shall be complied with:

a) the Seller has received the Rescission; and

b) the Seller has received the returned Goods.

6.5. In case the Purchaser has chosen other than the cheapest method of delivery of the Goods offered by the Seller, the Seller shall reimburse the costs for delivery of the Goods to the Purchaser in the amount equal to the cheapest offered method of delivery of the Goods.

6.6. For reimbursement of the purchase price for the Goods and costs for delivery of the Goods the same payment method shall be applied as applied by the Purchaser for making the payment of the purchase price of the Goods and costs for delivery of the Goods, unless agreed otherwise by the Parties.

6.7. The Purchaser is liable for a reduction of the value of the Goods resulting from handling such Goods in a manner different from the manner which is necessary for familiarisation with the nature and characteristics of the Goods, including its functionality. Should the Goods be damaged through a breach of the Purchaser´s obligation, the Seller shall be entitled to claim the compensation for reduction of the value of the Goods against the Purchaser and offset it against the refunded amount.

6.8. In case of a rescission of the Agreement the Purchaser shall bear direct costs connected with the return of the Goods, in particular the costs for delivery of the Goods to the Seller.

6.9. The Purchaser may not perform the Rescission in case it has removed the Goods from the packaging and for health reasons it is not possible to return it. Removal from the packaging means in particular a case where the Purchaser has removed the protective film of the packaging or similar protective means from the Goods protecting the contents of the Goods from hygienic or another spoilage.

 

7. Liability for Defects / Warranty

7.1. Rights and obligations of the Parties related to the rights for defective performance are governed by relevant generally binding legal regulations.

7.2. The Seller is liable towards the Purchaser that the Goods has no defects upon its takeover. The Seller is particularly liable towards the Purchaser that at the moment of the takeover of the Goods by the Purchaser:

a) the Goods has the composition (content) agreed by the Parties, and where an agreement is missing, it has the composition (content) described by the Seller or the producer or expected by the Purchaser considering the nature of the Goods and on the basis of the advertising performed by them;

b) the Goods are fit for the purpose presented by the Seller or for which the Goods of the same type are normally used;

c) the Goods are in appropriate quantity, volume or weight; and

d) the Goods comply with the requirements of the law of the Czech Republic.

7.3. During six months from takeover of the Goods it is expected that the manufacturing defect already existed upon the takeover of the Goods. If the Goods are lacking the above mentioned characteristics, the Purchaser may require delivery of new Goods free of defects, if it is not inappropriate, considering the nature of the defect. Should the defect relate only to a part of the Goods, the Purchaser may require replacement of the part; if this is not possible, he may rescind the Agreement. However, if this is inappropriate, considering the nature of the defect, particularly if the defect may be removed without undue delay, the Purchaser has the right to removal of the defect free of charge. The Purchaser has the right to delivery of new Goods or replacement of a part even in the case of a removable defect, in case he cannot use the Goods properly due to repeated occurrence of the defect after repair or due to more defects. In such case the Purchaser has the right to rescind the Agreement.

7.4. Should the Purchaser not rescind the Agreement or should he not exercise the right to delivery of new Goods free from defects or replacement of its part or repair of the Goods, he may require an appropriate discount. The Purchaser has the right to an appropriate discount also in the case that the Seller cannot deliver new Goods free of defects, replace its part or repair the Goods, as well as  in the case where the Seller fails to take corrective action within a reasonable period or that taking corrective action would give rise to considerable difficulties for the Purchaser.

7.5. The Purchaser has no right due to defective performance in case that the Purchaser was aware before the takeover of the Goods that the Goods were defective or in case the Purchaser himself has caused the defect. The Seller is not obliged to satisfy the Purchaser´s claim in case it proves that the Purchaser was aware of the defect on the Goods before the takeover or has caused it himself.

7.6. The Seller is not liable for defects occurred due to normal tear and wear or failure to observe the user instructions.

7.7. The Seller provides the Purchaser a warranty for the quality of Goods in the following length (“Warranty Period”):

a) for food supplements and Goods of similar nature until the application date or best before time indicated on the Goods or until the time during which such Goods should be consumed, as applicable, should their storage conditions be complied with by the Purchaser and the food supplement was not opened, excepting cases where it is necessary in order to identify the defect on such Goods;

b) for other consumer Goods for the period of 24 months.

7.8. By the warranty for quality, application time or best before time of the Goods the Seller undertakes that the Goods shall be for certain time ready for use for their normal purpose or that they shall retain their usual characteristics. These effects apply also to indication of the warranty period or application time or best before time of the Goods on the packaging or in advertising.

7.9. The warranty period runs from the handover of the Goods to the Purchaser. If the Goods were dispatched in accordance with the Agreement, it shall run from the delivery of the Goods to the destination pursuant to Article 3.1.

7.10. The Purchaser has no right under the warranty in case the defect was caused by an external event after transfer of the risk of damage on the Goods to the Purchaser.

7.11. The Purchaser is obliged to notify the Seller of the defect without undue delay after he might have discovered it in case of a timely inspection and sufficient care.

7.12. The Purchaser is entitled to make a complaint and according to his choice require for a defect that represents a substantial breach of the Agreement (regardless if the defect is removable or irremovable):

a) removal of the defect through delivery of new Goods free of defects or delivery of the missing Goods;

b) removal of the defect through repair free of charge;

c) appropriate discount on the purchase price;

d) refund of the purchase price on the basis of the Rescission.

7.13. For a defect that represents an insignificant breach of the Agreement (regardless if the defect is removable or irremovable), the Purchaser is entitled to removal of the defect or to an appropriate reduction of the purchase price of the Goods.

7.14. In case the removable defect has occurred repeatedly after repair (third complaint for the same defect or a fourth one for different defects) or the Goods have more defects (at least three defects simultaneously), the Purchaser may exercise the right to a reduction of the purchase price, replacement of the Goods or to rescind the agreement.

7.15. Articles 7.12 to 7.14 shall not be applied if the law stipulates for the Purchaser a wider or more favourable extent in exercising the rights of liability for defects during the Warranty Period, in which case the Purchaser has the rights provided by law.

7.16. The complaint including the right to removal of the defect must be raised with the Seller (in any establishment of the Seller). The Seller is obliged to issue for the Purchaser a written confirmation of the date by which the Purchaser has raised the complaint and the method of settlement of the complaint required by the Purchaser; and also a confirmation of the date and method of settlement of the complaint, including a confirmation of making the repair and its duration or a written justification of refusal of the complaint. The Seller or its authorized employee shall decide about the complaint immediately, in more complicated cases within three working days. This period does not take into account the period appropriate according to the product type or service necessary for an expert examination of the defect. The complaint including removal of the defect must be settled without undue delay, no later than within 30 days from raising the complaint, unless the parties agree on a longer period. Vain expiry of this time limit shall be regarded as a substantial breach of the Agreement.

7.17. The decision to use or apply the Goods is at the discretion and responsibility of the Purchaser. Information about the manner of use or application is included on the packaging of such Goods or in the communication which is placed inside the packaging of such Goods.

 

8. Extrajudicial Dispute Resolution

8.1. In case of a consumer dispute between the Parties arising from the Agreement which shall not be possible to resolve primarily by mutual agreement between the Parties, the Purchaser shall be entitled to make a proposal for extrajudicial resolution of such a dispute to the designated body of the extrajudicial consumer dispute resolutions, namely:

Consumer Centre Czech Republic (“ČOI”)

Central Inspectorate – Unit ADR

Štěpánská 15

120 00 Praha 2

Website ČOI: adr.coi.cz

E-mail address ČOI: adr@coi.cz.

8.2. Extrajudicial settlement of a consumer dispute is initiated solely at the Purchaser´s proposal, only in case that it was not possible to settle the dispute directly with the Seller. The proposal may be filed no later than within one (1) year from the date on which the Purchaser has exercised his right, which is the subject of the dispute, with the Seller for the first time.

8.3. Before the Purchaser turns to ČOI with the proposal for extrajudicial settlement of the dispute, he shall at first turn to the Seller with the request for settlement of the ongoing situation.

8.4. For settlement of a consumer dispute arising from an on-line concluded Agreement, the parties may also use an on-line form of extrajudicial resolution. The extrajudicial resolution of the dispute arising from the Agreement is initiated through a complaint filed on the electronic form.  For filing complaints and management of litigation there is a platform established by the European Commission on the below mentioned website for on-line dispute settlements (“Platform”). The website of the Platform: http://ec.europa.eu/consumers/odr/

8.5. The procedure pursuant to this Article 8. is not a mediation within the meaning of Act No. 202/2012 Coll., on Mediation, as amended, nor an arbitrary proceeding within the meaning of Act No. 216/1994 Coll., on Arbitration and Enforcement of Arbitral Awards, as amended, and its application is without prejudice to the entitlement of the Parties to address their claims to ČOI or a court.

8.6. During the period of a proceeding on extrajudicial settlement of the dispute the limitation and preclusion periods according to CC do not run and shall not commence to run , unless any Party to the dispute explicitly refuses to continue the proceeding.

 

9. Application for Natural Persons–Entrepreneurs and Legal Entities

9.1. Natural persons-entrepreneurs and legal entities are in case of purchases of Goods via E-shop regarded as the Purchasers and these Conditions shall apply for such purchases mutatis mutandis, with the exception of the provisions of Article 6 (Rescission of the Agreement) and Article 8 (Extrajudicial Dispute Resolution).

 

10. Final Provisions

10.1. Relations and any disputes arising under the Agreement shall be resolved exclusively according to the law of the Czech Republic and shall be resolved by competent courts of the Czech Republic.

10.2. The Agreement is concluded in the Czech language. Should a translation of the text of the Agreement be made for the Purchaser´s purpose, it is to be understood that in case of a dispute on the interpretation of the terms the interpretation of the Agreement in the Czech language shall prevail.

10.3. The parties declare that they have provided to each other all information necessary for conclusion of the Agreement.

10.4. Neither the Seller nor the Purchaser are entitled to assign the rights and obligations arising from this Agreement or this Agreement as a whole or its part to a third party without prior written consent of the other party.

10.5. The parties have agreed that the Purchaser is not entitled to offset any of his possible claims due to the Agreement against the Seller´s claim for monetary performance, arising on the basis and in connection with the Agreement.

10.6. Should any provision of the Agreement or the Conditions be invalid or ineffective or should it become invalid or ineffective, the invalid provisions shall be replaced with a provision as closest as possible to the invalid provision. Invalidity or ineffectiveness of one provision shall be without prejudice to the validity of the remaining provisions. Changes and amendments of the Agreement or the Conditions shall be made in written.

10.7. Both Parties assume the risk of a change of circumstances and the provision of Sections 1765(1) and 1766 of CC shall not be applied. The Purchaser declares that he is aware of the real value of the provided performance and agrees unreservedly with the agreed price of the performance.

10.8. In doubts whether the Goods were delivered or whether another act (call, sending of electronic or fax message, calls, reminder) was performed, the extract from the Seller´s system shall be relevant.

10.9. For service of documents between the Parties the Seller´s registered office and the Purchaser´s address of residence provided in the Order are considered as the delivery addresses.

10.10. Other matters not mentioned herein shall be governed by the Civil Code (No. 89/2012 Coll.), Consumer Protection Act (No. 634/1992 Coll.) and other legislation, as amended.

10.11. These Conditions, including their parts, are valid and effective from 1 June 2018 and repeal any and all previous versions of the Conditions, including their parts, and are available on the website of the E-shop.  

 

Annex to the General Commercial Terms and Conditions

Template form for rescission of the Agreement

(complete this form and send it back only in case you intend to rescind the Agreement)

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Notification of the Rescission of the Agreement

- Addressee (here the Seller shall input name and surname/business company, registered office and fax number and e-mail address of the Seller, if appropriate):

- I notify/we notify that I/we hereby rescind the Agreement

- Date of Order / date of receipt

- Name and surname of the Purchaser/Purchasers

- Address of the Purchaser/Purchasers

- Signature of the Purchaser/Purchasers (only if this form is sent in paper form)

- Date