(Fill in this Form and send it back only if you want to withdraw from the contract. The Form has to be printed, signed and sent scanned to the e-mail address below and/or attached to the shipment with returned goods). 

Addressee: CCF s.r.o., Santražiny 575, 760 01 Zlín

E-Shop: Mumijo.cz

Company: CCF s.r.o.

Address for sending: Santražiny 575, 760 01 Zlín

Company ID/VAT No.: IČ 26890771, DIČ CZ26890771

E-mail address: info@mumijo.cz 

Phone number: +420 571 623 624   

I declare that I hereby withdraw from the purchase contract of the following goods:

• Date of ordering:
• Order number:
• The funds for ordering and/or even for delivery, have been sent in the manner
  
  and will be returned in the manner (in case of transfer to the account, please send the account number)
• Name and surname of the consumer:
• Consumer address:
• E-mail:
• Tel.: 

In (fill-in the place here), on (fill-in the date here)

(signature)
______________________________________

Name and surname of the consumer