Withdrawal form

(fill in and send this form only if you wish to withdraw from the contract)

Whom:

Business name: Address: ID number: e-mail:

Macromo s.r.o Jeseniova 2760/56f, Žižkov, 130 00 Prague 3 14031493 info@macromo.org

I hereby announce that I exercise my legal right and withdraw from the contract for the provision of this service based on § 1829 paragraph 1 in conjunction with § 1818 of Act No. 89/2012 Coll., Civil Code, which refers to the goods listed below :

Order number *:

Order date* :

Date of receipt* :

Name / Business Name* :

Buyer's address* :

I wish to return the amount for the returned goods / service*:

to bank account / IBAN:

Date * :

Buyer's signature

(only if this form is submitted in paper form)