An example withdrawal form
(this form should be filled in and returned only if you wish to withdraw from the contract)

- Address: Store Ajmara.pl, ul. Zawiszy Czarnego 10/6, 41-506 Chorzow, Poland, sklep@ajmara.pl
- I / We (*) inform (*) about my / our withdrawal from the contract of sale of the following items (*) contract for the supply of the following items (*) contract for a work involving the following items (*) / for the provision of the following service (*)
- Date of conclusion of the contract (*) / receipt (*)
- Name and surname of consumer (s)
- Consumer (s) address
- Signature of consumer (s) (only if the form is sent in paper version)
- Date

(*) Delete as applicable.