........................................

                                                    Place, date

...............................................

................................................

Name and Surname of the Consumer(s)

Address of the Consumer(s)
                                                                     

To: Franz GL Magdalena Piwowarska - Szurogajło

ul. Heweliusza 1/16

60-281 Poznań

tel: +48 662 815 611

e-mail: info@franzgl.com

The Withdrawal Form

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*) ............................................................................................................

Ordered on (*)/received on (*),...............................................................

                                                              ...................................................                                                                      
                                 Signature of consumer(s) (only if this form is notified on paper)

(*) Delete as appropriate.