Termination of the contract

Appendix no. 2 to the Terms and Conditions of MIXDENT Online Store

FORM OF WITHDRAWAL (TEMPLATE)
(This form should be completed and returned in case you wish to withdraw from the contract)

MIXDENT Sp. z o.o.                                                    ………………………………………
Wojska Polskiego 82                                                         (place and date)
95-070 Aleksandrow Lodzki


I / We (*) ................................................ hereby inform on my / our (*) withdrawal from the sales contract of the following items (*) the contract for the supply of the following items (*) the specific work contract consisting in performing the following things (*) / the contract consisting in performance of the following services (*)
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Date of agreement (*) / receipt (*) .............................. ...........
Consumer's (s') name .................................... ......
Consumer's (s') address ......................................................

Consumer's (s') signature (only if the form is sent in hard copy)

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Date ...........................