Distance Sales Agreement

1. PARTIES

This Agreement has been signed between the parties below within the terms and conditions specified below.

A. “BUYER”; (hereinafter referred to as BUYER in the contract.)

B. “SELLER”; (hereinafter referred to as SELLER in the contract.)


1.1- SELLER

NAME-SURNAME: Can Jeff Savaryego (“SELLER” or “Alchemissi”)

ADDRESS: Küçükbakkalköy Mahallesi. Selvili Sokak. No:4 İç Kapı No: 20 Ataşehir/İstanbul

Tax ID Number: 7520621253

E-mail: info@alchemissi.com

Phone: +90 (551) 357 1917


1.2- BUYER: 

Within the scope of this agreement, the Buyer refers to the person/persons requesting to purchase goods/services from the Seller. The personal information provided by the Buyer while requesting to purchase from the Seller's website (www.alchemissi.com) shall be taken as the basis for the contract. (“BUYER”). 


1.3.- PARTIES:

Hereinafter, the Buyer and the Seller will be referred to as "PARTIES" together.

 

2. DEFINITIONS

In the application and interpretation of this agreement, the terms written below shall express the written explanations opposite them.

MINISTER: The Minister of Customs and Trade,

MINISTRY: The Ministry of Customs and Trade,

LAW: The Law on Consumer Protection No. 6502,

REGULATION: Distance Contracts Regulation (Official Gazette: 27.11.2014/29188)

SERVICE: The subject of any consumer transaction other than the provision of goods, performed or promised to be performed for a fee or benefit,

SELLER: The company that offers goods to the consumer within the scope of its commercial or professional activities, or acts on behalf or account of the one offering goods,

BUYER: A real or legal person who acquires, uses or benefits from a good or service for non-commercial or non-professional purposes,

SITE: The SELLER's website ("www.alchemissi.com")

ORDERER: A real or legal person who requests a good or service through the SELLER's website,

PARTIES: The SELLER and the BUYER,

PROVIDER: A real or legal person who provides services to the consumer for commercial or professional purposes, including public legal entities, or acts on behalf or account of the service provider,

CONTRACT: This agreement concluded between the SELLER and the BUYER,

GOODS: Refers to movable property subject to trade and intangible goods such as software, sound, images prepared for use in electronic environment.


3. SUBJECT OF THE CONTRACT:

3.1 This Agreement regulates the rights and obligations of the parties in accordance with the provisions of the Law on Consumer Protection No. 6502 and the Regulation on Distance Contracts regarding the sale and delivery of the product, the qualities and sales price of which are specified below, which the BUYER ordered electronically through the SELLER's website.


3.2 The prices listed and announced on the site are sales prices. Announced prices and promises are valid until updated and changed. Prices announced for a limited period are valid until the end of the specified period.


4. BUYER AND SELLER INFORMATION

 

4.1. - SELLER INFORMATION

Brand Name / Commercial Title: “Alchemissi” / Can Jeff Savaryego

Address: Küçükbakkalköy Mahallesi. Selvili Sokak. No:4 İç Kapı No: 20 Ataşehir/İstanbul

Phone: +90 (551) 357 1917

Email: info@alchemissi.com


4.2. - BUYER INFORMATION

Person to be Delivered to:

Delivery Address:

Phone/Fax: 

Email/username: 


5. PRELIMINARY INFORMATION

5.1 Before the contract is concluded (before ordering), the following information will be provided to the BUYER via a permanent data storage device in accordance with Law No. 6502 and the Distance Contracts Regulation:

  • Basic features of the products (soy wax, dimensions, color, scent, production technique, etc.)

  • Seller and provider information: title, full address, MERSİS / tax ID number, contact information

  • Contact information of the Seller and Provider and information on complaint resolution methods for consumers to submit their complaints

  • Price information: unit price, VAT if any, campaign or discount information

  • Delivery costs and method

  • Payment methods and additional fees, if any

  • Information and conditions regarding the right of withdrawal

  • Return conditions

  • Conditions for being bound by the contract after order confirmation

  • Information that consumers can apply to the Consumer Court or the Consumer Arbitration Committee for disputes.


6. ORDER AND CONCLUSION OF THE CONTRACT

6.1. When the BUYER selects a product on the website and proceeds to the "place order" step, an order summary (product, price, shipping, total amount) is displayed. The BUYER accepts this contract electronically by checking the "I have read, I accept" box; without this approval, the order cannot be completed. After the order and payment are completed, Alchemissi sends an order confirmation email to the consumer. This email serves as a contract confirmation. By accepting this contract, the BUYER acknowledges in advance that if they approve the order subject to the contract, they will be obligated to pay the order price and any additional fees such as shipping costs, taxes, and that they have been informed about this.


7. PRODUCT/PRODUCTS INFORMATION SUBJECT TO THE CONTRACT

7.1. The basic characteristics of the products/services (type, quantity, brand/model, color, number) are published on the SELLER's website. If the Seller has organized a campaign, the basic characteristics of the products and services within the scope of the campaign can be examined on the website throughout the campaign.

7.2. The prices listed and announced on the site are sales prices. Announced prices and promises are valid until updated and changed. Prices announced for a limited period are valid until the end of the specified period.

7.3. The sales price of the good or service subject to the contract, including all taxes, is shown below.


Product Description

Quantity

Unit Price

Subtotal

(Including VAT)

Shipping Cost

Total 

Payment Method and Plan

Delivery Address

Person to be Delivered to

Billing Address

Order Date

Delivery Date

Delivery Method


7.4. The shipping cost for product shipment will be paid by the BUYER unless otherwise specified.


8. INVOICE INFORMATION

Name/Surname/Title

Address

Phone

Fax

Email/username

Invoice delivery: The invoice will be sent as an e-invoice to the email address provided by the BUYER to the SELLER when placing the order, via email after the order. When the SELLER sends an e-invoice electronically, it is relieved of the obligation to send a physical invoice.


9. GENERAL PROVISIONS

9.1 By accepting this contract, the BUYER acknowledges in advance that if they approve the order subject to the contract, they will be obligated to pay the order price and any additional fees such as shipping costs, taxes, and that they have been informed about this.

9.2 The BUYER and the SELLER acknowledge, declare, and undertake that the SELLER is responsible for delivering the product subject to the contract in a sound, complete manner, in accordance with the specifications stated in the order, and based on the descriptions provided on the listing page for the product.

9.3 The BUYER acknowledges and declares that before this Agreement, they have read and understood all information about the product, including but not limited to its basic features, sales price, payment method, additional payments, and delivery information, as well as the product/service information specified in Article 5 of this Agreement, which are provided by the SELLER on the listing page, and that they have given the necessary confirmation before concluding this Agreement. The BUYER acknowledges, declares, and undertakes that by confirming the Preliminary Information electronically, they have correctly and completely obtained the address to be given by the SELLER to the BUYER, the basic features of the ordered products, the prices of the products including taxes, and the payment and delivery information, before the distance sales contract is concluded.

9.4 The BUYER accepts, declares and undertakes that he/she has approved the preliminary information form regarding the product/service before this Contract.

9.5 The Parties accept, declare and undertake to comply with the provisions of the Law on Consumer Protection and the Regulation on Distance Contracts, as well as the terms of this Agreement.

9.6 All articles of this Agreement have been read and accepted by the SELLER and the BUYER, and this Agreement enters into force on the date it is approved electronically by the BUYER.

9.7 The SELLER will ship the product subject to the Contract within the period specified in the preliminary information text. The product subject to the Contract will be sent via the cargo company with which the SELLER has an agreement. Unless otherwise specified by the SELLER, the shipping (cargo) fee for orders will be paid by the BUYER.

9.8 The BUYER acknowledges and declares that when they approve this contract through the electronic system, the contract is established, and they are aware that they incur a payment obligation under the contract and will make the payment.

9.9 For the BUYER to make a payment by credit card, they must fill in their credit card information completely and accurately in the relevant section. Payment can be made in a single installment by credit card. In accordance with the agreements between the BUYER and the Bank, the Bank may provide installment options to the BUYER from time to time within the framework of its own campaigns. In installment transactions, the relevant provisions of the contract signed between the Buyer and the bank apply. The bank may organize campaigns and apply a higher number of installments than the BUYER chooses, and may offer services such as deferring installments. Such campaigns are at the discretion of the Bank. The BUYER acknowledges, declares, and undertakes that since installment sales are made only with credit cards belonging to banks, they will separately confirm the relevant interest rates and default interest information with their bank, and that the provisions regarding interest and default interest will be applied within the scope of the credit card agreement between the bank and the Buyer in accordance with the current legislation. Product sales where installments are made by the Bank and the Seller collects the full amount are not considered installment sales for the purposes of this Agreement, but cash sales. In this case, the default interest is subject to the terms of the agreement between the Bank and the BUYER.

If, for any reason, the product price is not paid or is cancelled in the bank records, the Seller is considered to be released from the obligation to deliver the product.

9.10 If the BUYER is not present at the address at the time of delivery of the product and the persons at the address do not accept the delivery, the SELLER will be deemed to have fulfilled its performance. It is the BUYER's responsibility to follow up on the shipment of the products by contacting the cargo company if there is no one to receive the delivery at the address.

If the product is to be delivered to a person/organization other than the BUYER, the SELLER cannot be held responsible if the person/organization to be delivered to is not at the address or does not accept the delivery. In such cases, all damages arising from the BUYER's late receipt of the product and the expenses incurred due to the product waiting at the cargo company and/or the return of the cargo to the SELLER shall also belong to the BUYER.

9.11 The BUYER is responsible for checking the product at the time of delivery and, if they see a problem caused by the cargo, refusing the product and having a report prepared by the cargo company official. Otherwise, the SELLER will not accept responsibility.

9.12 If the SELLER determines that the product subject to the contract cannot be supplied for any reason, it may supply another product of equal quality and price, provided that it informs the BUYER clearly within 3 (three) days from the date it learns of this situation, in accordance with the law, and obtains the BUYER's verbal or written consent. In this case, the SELLER shall be deemed to have fulfilled its commitment under the Contract. The Buyer is free to give or not give this consent, and if they cancel their order by not giving consent, the total amount paid will be refunded to the relevant bank within 14 (fourteen) days.

9.13 The Buyer acknowledges and declares that their personal data will be processed by the Seller for the purpose of contract performance, within the scope of the Personal Data Protection Law No. 6698 and relevant legislation, and that they have been informed about this.

9.14 Each product subject to the contract shall be delivered to the BUYER or the person and/or organization at the address indicated by the BUYER within the period specified in the preliminary information section on the website, depending on the distance of the BUYER's residence, provided that it does not exceed the legal period of 30 days. In the event that the product cannot be delivered to the BUYER within this period, the BUYER reserves the right to terminate the contract. 

9.15 The SELLER accepts, declares, and undertakes to deliver the product subject to the Contract complete, in accordance with the specifications stated in the order, and with any warranty documents, user manuals, and information and documents necessary for the job, to perform the work in a sound manner in accordance with legal regulations and standards, truthfully and honestly, to maintain and improve service quality, to exercise due care and diligence during the performance of the work, and to act with caution and foresight.

9.16 The BUYER acknowledges, declares, and undertakes that they will confirm this Agreement electronically for the delivery of the product subject to the Contract, and that the SELLER's obligation to deliver the product subject to the Contract will cease if the product price is not paid for any reason and/or is cancelled in the bank records.

9.17 The BUYER acknowledges, declares and undertakes that in the event that the credit card belonging to the BUYER is used unfairly by unauthorized persons after the delivery of the product subject to the contract to the BUYER or the person and/or organization at the address indicated by the BUYER, and the product price subject to the contract is not paid to the SELLER by the relevant bank or financial institution, the BUYER will return the product subject to the contract to the SELLER within 3 days, with the shipping costs belonging to the BUYER.

9.18. The SELLER acknowledges, declares, and undertakes to inform the BUYER within a reasonable period if the product subject to the contract cannot be delivered on time due to force majeure events such as events beyond the control of the parties, unforeseen, and preventing and/or delaying the parties from fulfilling their obligations. The BUYER also has the right to request from the SELLER to cancel the order, replace the product subject to the contract with an equivalent if available, and/or postpone the delivery period until the hindering situation is eliminated. If the BUYER cancels the order, in case of cash payments made by the BUYER, the product amount will be paid to them in cash and in full within 14 days. In case of credit card payments made by the BUYER, the product amount will be refunded to the relevant bank within 14 days after the order is cancelled by the BUYER. The BUYER acknowledges, declares, and undertakes that the average process for the amount refunded to the credit card by the SELLER to be reflected in the BUYER's account by the bank may take 2 to 3 weeks, and that the reflection of this amount in the BUYER's accounts after it is refunded to the bank is entirely related to the bank's processing time, therefore the BUYER cannot hold the SELLER responsible for any possible delays.

9.19 The SELLER has the right to contact the BUYER for communication, marketing, notification and other purposes via mail, e-mail, SMS, phone calls and other means using the address, e-mail address, landline and mobile phone numbers and other communication information provided by the BUYER in the registration form on the site or updated by them later. The BUYER, by accepting this contract, acknowledges and declares that the SELLER may carry out the aforementioned communication activities towards them.

9.20 The BUYER shall inspect the goods/services before receiving them; they shall not accept damaged or defective goods/services such as crushed, broken, torn packaging, etc., from the cargo company. It shall be accepted that the received goods/services are undamaged and intact. After delivery, the responsibility to protect the goods/services with care belongs to the BUYER. If the right of withdrawal is to be exercised, the goods/services should not be used. The invoice must be returned.

9.21. If the BUYER and the credit card holder used during the order are not the same person, or if a security vulnerability related to the credit card used in the order is detected before the product is delivered to the BUYER, the SELLER may request the BUYER to provide identification and contact information of the credit card holder, the credit card statement from the previous month for the credit card used in the order, or a letter from the card holder's bank confirming that the credit card belongs to them. The order will be put on hold until the BUYER provides the requested information/documents, and if these requests are not met within 24 hours, the SELLER reserves the right to cancel the order.

9.22. The BUYER declares and undertakes that the personal and other information they provide when becoming a member of the SELLER's website is true, and that they will immediately compensate the SELLER in cash and in full for all damages incurred by the SELLER due to the falsity of this information, upon the SELLER's first notification.

9.23. The BUYER agrees and undertakes from the outset to comply with the provisions of the legal legislation and not to violate them while using the SELLER's website. Otherwise, all legal and criminal liabilities that may arise shall belong solely and exclusively to the BUYER.

9.24. The BUYER may not use the SELLER's website in a way that disrupts public order, is contrary to general morals, disturbs or harasses others, for an unlawful purpose, or infringes on the material and moral rights of others. In addition, the member cannot engage in activities (spam, virus, trojan horse, etc.) that prevent or make it difficult for others to use the services.

9.25. Links to other websites and/or other content that are not under the SELLER's control and/or owned and/or operated by other third parties may be provided by the SELLER on the SELLER's website. These links are provided to facilitate navigation for the BUYER and do not endorse any website or the person operating that site and do not constitute any guarantee for the information contained on the linked website.

9.26. Any member who violates one or more of the articles listed in this contract shall be personally responsible criminally and legally for such violation and shall indemnify the SELLER from the legal and criminal consequences of these violations. Furthermore, in the event that this violation leads to legal action, the SELLER reserves the right to claim compensation from the member for non-compliance with the membership agreement.


10. RIGHT OF WITHDRAWAL

10.1. In the case of a distance contract for the sale of goods, the BUYER may exercise their right of withdrawal by rejecting the goods without incurring any legal or criminal liability and without stating any reason, provided that they notify the SELLER within 14 days from the date of delivery of the product to themselves or the person/organization at the address they indicated. In distance contracts for the provision of services, this period starts from the date the contract is signed. The right of withdrawal cannot be exercised in service contracts where the performance of the service has started with the consumer's consent before the right of withdrawal period expires. The costs arising from the exercise of the right of withdrawal belong to the SELLER. By accepting this contract, the BUYER acknowledges in advance that they have been informed about the right of withdrawal.

10.2. To exercise the right of withdrawal, a written notification must be sent to the SELLER's e-mail address (info@alchemissi.com) specified in the contract within 14 (fourteen) days, clearly stating the intention to withdraw, and the product must not have been used within the framework of the "Products for which the Right of Withdrawal Cannot Be Exercised" provisions regulated in this contract. If this right is exercised:

  1. The invoice of the product delivered to the 3rd party or the BUYER (if the invoice of the product to be returned is corporate, it must be sent with the return invoice issued by the institution. Order returns invoiced to institutions cannot be completed without a return invoice.)

  2. Return form,

  3. The products to be returned must be delivered complete and undamaged, with their box, packaging, and standard accessories, if any.

10.3. The SELLER is obliged to refund the total amount and the documents that put the BUYER in debt to the BUYER within a maximum of 14 days from the date the withdrawal notification reaches him, and to take delivery of the goods returned by the BUYER.

10.4. The BUYER or the 3rd Party to whom the goods were delivered must return the goods to the SELLER or provider or to the person authorized by the SELLER within 10 (ten) days from the date on which the BUYER's notification regarding the exercise of the right of withdrawal was directed. Here, returns made to the SELLER's address, "Küçükbakkalköy Mah. Selvili Sokak. No:4 İç Kapı No: 20 Ataşehir / İstanbul", will be considered valid. The BUYER must send the goods via the cargo company with which the SELLER has an agreement. Otherwise, the shipping costs must be borne by the BUYER. The details of the relevant cargo company will be notified to the BUYER by the SELLER using the communication channels specified in this contract when the BUYER sends the withdrawal notification in writing to the SELLER.

10.5. If there is a decrease in the value of the goods due to a fault of the BUYER or if the return becomes impossible, the BUYER is obliged to compensate the SELLER's damages in proportion to their fault.

10.6. If the campaign limit amount organized by the SELLER falls below due to the exercise of the right of withdrawal, the discount amount utilized within the scope of the campaign will be cancelled.

10.7. In cases where the right of withdrawal can be exercised, the BUYER is legally responsible for any changes or deterioration that occur if the product is not used in accordance with its operation, technical specifications, and usage instructions within the withdrawal period. In this context, if a change or deterioration occurs in the product due to its non-use in accordance with its operation, technical specifications, and usage instructions until the date of withdrawal, the BUYER loses the right of withdrawal. In cases where the SELLER accepts the right of withdrawal despite this, a discount may be made from the refunded product price for the amount of change/deterioration.


11. PRODUCTS FOR WHICH THE RIGHT OF WITHDRAWAL CANNOT BE EXERCISED

11.1 - The Parties have agreed that the right of withdrawal cannot be exercised in the following cases, in accordance with Article 15/1 of the Distance Contracts Regulation:

  • a) Goods or services whose prices vary depending on fluctuations in financial markets and are not under the control of the seller or provider,

  • b) Goods prepared in line with the consumer's wishes or personal needs,

  • c) Goods that are perishable or whose expiry date may pass,

  • d) From goods whose protective elements such as packaging, tape, seal, package have been opened after delivery; those whose return is not suitable for health and hygiene, burnt candles, used soaps, opened room fresheners (deterioration will occur in the product due to volatility).

  • e) Goods that are mixed with other products after delivery and cannot be separated by their nature,

  • f) Books, digital content, and computer consumables provided in a material environment, if protective elements such as packaging, tape, seal, package have been opened after delivery,

  • g) Periodicals such as newspapers and magazines, except those provided under a subscription contract, Limited Edition products produced periodically after their sales period has passed, 

  • h) Services related to accommodation, freight transport, car rental, food and beverage supply, and leisure time for entertainment or recreation purposes that must be performed on a specific date or period,

  • ı) Services performed instantly in electronic environment or intangible goods delivered instantly to the consumer,

  • i) Services whose performance has begun with the consumer's consent before the right of withdrawal period expires.


11.2. Within the scope of this contract, the BUYER cannot exercise the right of withdrawal for cosmetic products, burned candles, opened room fresheners, used soaps, and products that are not suitable for resale, as well as products for which the right of withdrawal cannot be exercised under this contract and the Law and Regulation.


12. DEFAULT AND LEGAL CONSEQUENCES

12.1 If the BUYER defaults on their credit card payments, they acknowledge, declare, and undertake to pay interest within the framework of the credit card agreement with the card-issuing bank and to be responsible to the bank. In this case, the relevant bank may resort to legal remedies; it may demand the resulting expenses and attorney's fees from the BUYER, and in any event, if the BUYER defaults on their debt, the BUYER acknowledges, declares, and undertakes to pay the SELLER for the damage and loss incurred by the SELLER due to the delayed performance of the debt. The SELLER cannot be held responsible for any of these circumstances. 


13. NOTIFICATIONS

13.1 The BUYER is obliged to make all notifications, including the withdrawal notification, in writing using the SELLER's contact information provided in this contract. The withdrawal notification must be submitted in writing to the email address info@alchemissi.com.


14. SECURITY-PRIVACY, PERSONAL DATA, ELECTRONIC COMMUNICATIONS AND INTELLECTUAL-INDUSTRIAL PROPERTY RIGHTS RULES

14.1 The privacy rules-policy and terms, the current principles of which are specified below, are valid for the protection, confidentiality, processing-use of information and communications and other matters on the SELLER's website (www.alchemissi.com).

14.1.1. The necessary measures for the security of information and transactions entered by the BUYER on the Website (www.alchemissi.com) have been taken within the system infrastructure on the SELLER's side, to the extent of current technical possibilities, depending on the nature of the information and transaction. However, since the said information is entered from the BUYER's device, the BUYER is responsible for taking necessary precautions, including those related to viruses and similar harmful applications, to protect them on the BUYER's side and prevent unauthorized access. Despite all precautions taken by the SELLER, the SELLER is not responsible for faults and damages occurring due to the fault of the web service provider it uses or due to the BUYER.

14.1.2 In addition to and in confirmation of the BUYER's permissions-consents regarding personal data and commercial electronic communications provided otherwise; the SELLER may record the information acquired during the BUYER's membership and purchases on the website (www.alchemissi.com) indefinitely or for a period determined by them, for electronic and other commercial-social communications to be made for the purpose of providing various products/services and for all kinds of information, advertising-promotion, communication, promotion, sales, marketing, store card, credit card and membership applications, within the scope of the stated persons and their successors, store them in printed/magnetic archives, update them when deemed necessary, share them with domestic and foreign partner companies, transfer them, use them and process them in other ways. This data may also be transmitted to the relevant authorities and courts when required by law. The BUYER has consented and permitted the use, sharing, processing of their existing and new personal and non-personal information, and the sending of commercial and non-commercial electronic communications and other communications to them within the scope of the above, in accordance with the legislation on the protection of personal data and electronic commerce legislation.

14.1.3. The BUYER can stop data usage-processing and/or communications at any time by reaching the SELLER through the specified communication channels or by reaching through the same channels in accordance with legal procedures or by using the right to refuse in the electronic communications sent to them. According to the BUYER's explicit notification in this regard, personal data processing and/or communications to them will be stopped within the legal maximum period; furthermore, if desired, information other than those legally required to be retained and/or possible will be deleted from the data recording system or anonymized in a way that their identity cannot be determined. If the BUYER wishes, they can always apply to the SELLER through the above communication channels and obtain information on matters such as transactions related to the processing of their personal data, the persons to whom it is transferred, correction if it is incomplete or incorrect, notification of corrected information to relevant third parties, deletion or destruction of data, objection to a result against them by analyzing through automatic systems, and compensation for damages in case of unlawful processing of data. Applications and requests in these matters will be fulfilled within the legal maximum periods or may not be accepted with legal justification explained to them.

14.1.4. All information and content belonging to the website (www.alchemissi.com), and their arrangement, revision and partial/complete use; except for those belonging to other third parties according to the SELLER's agreement; all intellectual-industrial rights and property rights belong to the SELLER.

14.1.5. The SELLER reserves the right to make any changes it deems necessary in the matters mentioned above; these changes become effective from the moment they are announced by the SELLER on the Website (www.alchemissi.com) or by other appropriate methods.

14.1.6. On other sites accessed from the Website (www.alchemissi.com), their own privacy-security policies and terms of use apply, and the SELLER is not responsible for any disputes or negative consequences that may arise.


15. AUTHORIZED COURT

In disputes arising from this contract, the Consumer Arbitration Committees in the BUYER's place of residence are authorized for values up to the amount announced by the Ministry of Customs and Trade each year, and the Consumer Courts are authorized for disputes exceeding this value.


16. EFFECTIVENESS

The BUYER shall be deemed to have accepted all terms of this contract when they make the payment for the order placed through the Site. The SELLER is obliged to make the necessary software arrangements on the site to obtain confirmation from the BUYER that they have read and accepted this contract before the order is placed.


This contract has been concluded on the date the order was placed by the BUYER through the SELLER's Website (www.alchemissi.com) in accordance with the provisions of this contract.

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APPENDIX

SAMPLE WITHDRAWAL FORM

(This form will only be filled out and sent when the right of withdrawal is desired to be exercised from the contract.)

- To: (This section, to be filled by the seller or provider, will contain the name, title, address, fax number if any, and e-mail address of the seller or provider.)

- I hereby declare that I am exercising my right of withdrawal from the contract for the sale of the following goods or the provision of the following services with this form.

- Order date or delivery date:

- Good or service subject to the right of withdrawal:

- Price of the good or service subject to the right of withdrawal:

- Consumer's name and surname:

- Consumer's address:

- Consumer's signature: (Only if sent on paper)

- Date: