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Full Name_______________________


Passport Series ___________________

Date of Issue  ___________________

Phone Number ___________________





I hereby request a refund for the following item 


(in accordance with the consumer's right as per the article of the Law of Ukraine "On Consumer Protection", including the name of the product)


Purchased on ___________ as per order № _________________

due to the fact that the purchased item did not suit me ____________________________

(in terms of shape, dimensions, style, color, size)

 Amount ___________________________________________________________________

(amount in words)


to be refunded to the card number ____________________________________________________________________.

                             (card number from which the payment was made)


I confirm that the item was not used by me, and it retains its original condition and tags.

Date: « _» _______ 202                                                                          

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