To: PESCUIT SPORTIV S.R.L. (Fisher's Home), IDNO 1011600025790,
9/4 Liviu Deleanu St., Chișinău, e-mail: info@sportex-fishing.md

I/We (*) hereby give notice that I/we (*) withdraw from my/our (*) contract
for the sale of the following goods:
______________________________________________________________

Order number: ______________________
Ordered on (*) / received on (*): ______________________
Name of consumer(s): ______________________
Address of consumer(s): ______________________
Phone / e-mail (optional): ______________________
Payment method: online card (maib) / cash on delivery (*)
For cash on delivery – refund: cash at the store / bank transfer to IBAN
______________________ (*)

Signature of consumer(s)
(only if this form is sent on paper): ______________________

Date: ______________________

(*) Delete as appropriate.