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Withdrawal Form

 

Send data by email to This email address is being protected from spambots. You need JavaScript enabled to view it. or by registered mail to "Piera Gabrieli via Bosco, 12 35020 Correzzola (PD)"

Customer Data (required)

Name and Surname
Email
Address
ZIP Code
City and State
Telehone number

Order Information (All fields are required)
Order number
Amount
Product code
Product name
Reason for refund
Action required (tick the correct text)
REPLACEMNT GOODS
REFUND

When a refund you must fill out the form below

The undersigned requests the enforcement of the following bank transfer:
Beneficiary (name and surname)
Address
ZIP Code
City and State
VAT ID
IBAN Code

Signature
___________