Complaint form

Complaint form

COMPLAINTS UNDER WARRANTY

Filled in by the customer

DETAILS SELLER

e:Exq Marta Koniarska

ul. Lipowa 2B lok. 16, 81-572 Gdynia

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CLIENT DETAILS

First name and last name:

Address for correspondence:

Email address:

DETAILS OF THE SALES AGREEMENT

Order number:

The date of sale agreement:

The number of VAT invoice / receipt and the date of issue (optional) or information about other proof of purchase:

IDENTIFICATION OF ADVERTISED GOODS

Description of goods (eg. type, model - symbol):

Price of goods:

DEFINITION OF DEFECTS

Description of defects

Date of estimation defects in the goods:

CUSTOMER DEMAND (please indicate the appropriate)

A

The free repair of the goods (removal of defects)

B

The free exchange of goods for new

C

Lowering the price of goods

The amount of the price reduction:

D

Withdrawal from the contract and demand the return of money
(The customer can not withdraw from the contract if the defect is irrelevant)

REFUND (applies only to reduce the price of the goods or withdraw from the contract and demand the return of money)

The name of the bank and bank account number of the customer (or any other way to return the money):

CLIENT OTHER NOTES 

DATE, PLACE AND SIGNATURE OF CUSTOMER

Place, date:

Customer's signature (only if the form is sent on paper)