Model Withdrawal Form

Complete and return this form only if you wish to withdraw from the contract.

To: ინდივიდუალური მეწარმე არტურ ბოჯენკო / Individual Entrepreneur Artur Bozhenko, საქართველო, ქალაქი ბათუმი, ალექსანდრე პუშკინის ქუჩა N119-121 / Georgia, Batumi, Aleksandre Pushkin str. 119-121, [email protected]

I/we hereby give notice that I/we withdraw from the contract of sale of the following goods: ______________________
Order number: ______________________
Received on: ______________________
Name of consumer: ______________________
Address of consumer: ______________________
Signature (paper form only): ______________________
Date: ______________________