Complaint and Exchange Form

Complaint and Exchange Form

I request a complaint / exchange for the purchased goods.

(Please select whether this is a complaint or an exchange. Cross out the option that does not apply.)

Sender (Buyer):

Full Name / Company Name: …………………………………………..

Address / Place of Business / Company Headquarters: …………………………………………..

Phone: …………………………………………..

E-mail: …………………………………………..

Order Number: …………………………………………..

Date of Contract Conclusion: …………………………………………..

Date of Receipt of Goods: …………………………………………..

Description of the complaint or reason for the exchange:

……………………………………………………………………………………………………………………………………

Bank account number for refund:

………………………………………….. / ……………………..

I hereby declare that if my complaint is accepted, I request a refund of the purchase amount to the bank account mentioned above.

Purchase agreement No. ………………………………………. concluded on ……………………………………….

and I request a refund to the above-mentioned bank account.

In ……………………………. on ……………………..

Signature of Buyer (required only if the form is submitted in printed form)

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