Receipt and Handover Form for Product Complaint

(fill out and send this form only if you wish to file a complaint about a product)

I hereby notify that I am filing a complaint regarding a product purchased from Hana Godušová, Lermontovova 911/3 81105 Bratislava, IČO: 50195000, IČ DPH: SK1121316911

(hereinafter referred to as the "seller").

Order or Invoice Number:

Date of Order (Invoice Issue Date):

Description of Product Damage:

 

Buyer Information:

Name:

Address for sending the resolved complaint:  

Phone Contact:

 

Receipt Date: 

  .............................. ..............................

 receiver's name                                          sender's name

Please send the claimed product via courier service along with this form to the following address:

Hana Godušová, Veľký Lapáš, 951 04, Veľký Lapáš 8460