Fill in the form below only in case of withdrawal from the contract. Please return it to one of the contact details shown.
Recipient
BIONIKA Medline Kft.
3516 Miskolc, Tégla u. 29., Hungary
Email: info@bionika.hu
Phone: +36 20 964 4146
Declaration
I, the undersigned, declare that I exercise my right of withdrawal for the contract of purchase for the following product(s):
- Order number: ………………………………………………………
- Product name: ………………………………………………………
- Date of conclusion of contract / date of receipt: ………………………
- Consumer's name: ………………………………………………………
- Consumer's address: ………………………………………………………
- Signature of the consumer (only in case of a paper-based declaration): ……………………
- Date: ………………………………………………………