Terms of service

TERMS AND CONDITIONS OF ONLINE STORE

EYEON.DESIGN

TABLE OF CONTENTS:

  1. GENERAL PROVISIONS
  2. ELECTRONIC SERVICES IN THE INTERNET SHOP
  3. CONDITIONS OF CONCLUDING SALES AGREEMENT
  4. WAYS AND DEADLINES OF PAYMENT FOR THE PRODUCT
  5. COST, WAYS AND TIME OF DELIVERY AND COLLECTION OF THE PRODUCT
  6. PRODUCT COMPLAINT
  7. OUT-OF-COURT WAYS OF DEALING WITH COMPLAINTS AND CLAIMS, AND RULES OF ACCESS TO THESE PROCEDURES
  8. RIGHT OF WITHDRAWAL
  9. PROVISIONS CONCERNING ENTREPRENEURS
  10. OPINIONS IN AN ONLINE STORE
  11. FINAL PROVISIONS
  12. MODEL WITHDRAWAL FORM

The online store www.eyeon.design cares about consumer rights. The consumer may not waive the rights granted to him by the Act on Consumer Rights. Provisions of the agreements less beneficial to the consumer than the provisions of the Consumer Rights Act are invalid, and in their place the provisions of the Consumer Rights Act shall apply. Therefore, the provisions of these Terms and Conditions are not intended to exclude or limit any consumer rights to which they are entitled under mandatory provisions of law, and any possible doubts shall be interpreted in favour of the consumer. In the event of any inconsistency between the provisions of these Regulations and the aforementioned regulations, these regulations shall prevail and shall be applied.

1. GENERAL PROVISIONS

1.1The On-line store available at the Internet address www.eyeon.design is owned and operated by Eye on Design K.Żebrowska P.Horyza, a partnership based in Warsaw (02-769), 257/86 Pulawska St., NIP: 5213894685, Regon: 385855520, e-mail address: store@eyeon.design.

1.2These Regulations are addressed both to consumers and businesses using the Online Store (with the exception of point. 9 of the Regulations, which is addressed exclusively to entrepreneurs).

1.3The Administrator of personal data processed in connection with the provisions of these Regulations is the Service Provider. Personal data shall be processed for the purposes, within the scope and on the basis of principles indicated in Privacy Policy published on the pages of the Internet Shop. Providing personal data is voluntary. Any person whose personal data is processed by the Service Provider shall have the right to inspect its content and the right to update and correct it.

1.4Definitions:

  • WORKING DAY - one day from Monday to Friday excluding public holidays.
  • REGISTRATION FORM - a form available in the Online Store that allows the creation of an Account.
  • ORDER FORM - Electronic Service, an interactive form available in the Online Store, enabling the placement of an Order, in particular by adding Products to an electronic basket and determining the terms of a Sales Agreement, including the method of delivery and payment.
  • CUSTOMER - (1) a natural person with full capacity to perform legal actions, and in cases provided for by generally applicable laws, also a natural person with limited capacity to perform legal actions; (2) a legal person; or (3) an organizational unit without legal personality, which is granted legal capacity by the law; - who has concluded or intends to conclude a Sales Agreement with the Seller.
  • CIVIL CODE - the Civil Code Act of 23 April 1964. (Journal of Laws 1964 no. 16, item 93 as amended).
  • ACCOUNT - Electronic Service, marked with an individual name (login) and password given by the Customer, a set of resources in the Service Provider's ICT system, which stores data given by the Customer and information about Orders placed by him/her in the Online Store.
  • PRODUCT - a movable item available in the Online Shop, which is the subject of a Sales Agreement between the Client and the Seller.
  • RULES - these terms and conditions of the Online Store.
  • INTERNET SHOP - the Service Provider's Internet shop available at the following Internet address: www.eyeon.design.
  • SELLER; SERVICE PROVIDER - Eye on Design K.Żebrowska P.Horyza spółka cywilna with its registered seat in Warsaw (02-769), ul. Puławska 257/86, NIP: 5213894685, Regon: 385855520.
  • SALE AGREEMENT - a contract of sale of a Product entered into or concluded between the Client and the Seller through the Online Store.
  • ELECTRONIC SERVICE - a service provided electronically by the Service Provider to the Customer through the Online Store.
  • USER - (1) a natural person with full capacity to perform legal actions, and in cases provided for by generally applicable regulations also a natural person with limited capacity to perform legal actions; (2) a legal person; or (3) an organizational unit without legal personality, which is granted legal capacity by the Act; - using or intending to use the Electronic Service.
  • CONSUMER RIGHTS ACT, ACT - the Act of 30 May 2014 on consumer rights (Journal of Laws 2014 item 827 as amended).
  • ORDER - the Customer's declaration of will made via the Order Form and aimed directly at concluding a Product Sales Agreement with the Seller.

2. ELECTRONIC SERVICES IN THE ONLINE STORE

2.1The following Electronic Services are available at the Online Shop: Account and Order Form.

  • Account - use of the Account is possible after completing three consecutive steps by the Customer - (1) completing the Registration Form, (2) clicking on "Register" and (3) confirming the desire to create an Account by clicking on the confirmation link sent automatically to the provided e-mail address. In the Registration Form it is necessary for the Service Recipient to provide the following data: e-mail address and password.
  • Order Form - using the Order Form starts from the moment the Customer adds the first Product to the electronic basket in the Internet Shop. The Order is placed when the Customer completes two consecutive steps in total - (1) filling in the Order Form and (2) clicking the "I'm ordering" button on the Shop's website after filling in the Order Form. - Until this moment, it is possible to modify the data entered on your own (for this purpose, please follow the messages displayed and the information available on the website of the Online Store). In the Order Form it is necessary to provide the following data concerning the Customer: name and surname/company name, address (street, house/flat number, postal code, town, country), e-mail address, contact phone number and data concerning the Sales Agreement: Product/s, quantity of Product/s, place and method of delivery of Product/s, method of payment. In the case of Customers who are not consumers, it is also necessary to provide their company name and NIP number.

2.2Technical requirements necessary for working with the tele-information system used by the Service Provider: (1) computer, laptop or other multimedia device with access to the Internet; (2) access to electronic mail; (3) web browser: Mozilla Firefox version 17.0 and higher or Internet Explorer version 10.0 and higher, Opera version 12.0 and higher, Google Chrome version 23.0. and higher, Safari version 5.0 and higher; (4) recommended minimum screen resolution: 1024x768; (5) enable Cookies and Javascript in the web browser.

2.3The Customer is obliged to use the Online Store in a manner consistent with the law and good practice with respect to personal rights and copyrights and intellectual property of the Service Provider and third parties. The recipient is obliged to enter data consistent with the facts. The recipient is prohibited to provide unlawful content.

2.4Complaints procedure:

  • Complaints related to the provision of Electronic Services by the Service Provider and other complaints related to the operation of the Online Shop (excluding the Product complaint procedure, which is indicated in pt. 6 of the Terms and Conditions) may be submitted in electronic form via e-mail to: store@eyeon.design;
  • The Customer is advised to provide in the description of the complaint: (1) information and circumstances concerning the subject matter of the complaint, in particular the type and date of the irregularity; (2) the Client's request; and (3) the contact details of the complainant - this will facilitate and expedite the processing of the complaint by the Service Provider. The requirements specified in the preceding sentence are only a recommendation and do not affect the effectiveness of complaints submitted without the recommended description of the complaint.
  • The Service Provider shall respond to the complaint immediately, but not later than within 14 calendar days from the date of its submission.

3. CONDITIONS OF CONCLUDING THE CONTRACT OF SALE

3.1The conclusion of the Sales Agreement between the Customer and the Seller takes place after placing an Order by the Customer with the help of the Order Form in the Online Shop in accordance with point 2.1.2 of the Terms and Conditions. 2.1.2 of the Regulations.

3.2The Product price displayed on the website of the Online Shop is given in Polish zloty and includes taxes. About the total price including taxes of the Product being the subject of the Order, as well as about the costs of delivery (including fees for transport, delivery and postal services) and about other costs, and if it is not possible to determine the amount of these fees - about the obligation to pay them, the Customer is informed on the pages of the On-line Shop in the course of placing the Order, including also at the moment of expressing by the Customer the will to be bound by the Sales Agreement.

3.3Procedure of concluding a Sales Agreement at the On-line Shop by means of the Order Form

  • The conclusion of the Sales Agreement between the Customer and the Seller takes place after placing an Order by the Customer on the Online Shop, in accordance with point 2.1.2 of the Terms and Conditions. 2.1.2 of the Regulations.
  • After placing an Order, the Seller shall immediately confirm its receipt and simultaneously accept the Order for execution. Confirmation of receipt of the Order and its acceptance for execution takes place by sending by the Seller to the Client an appropriate e-mail message to the e-mail address given during the placement of the Order, which contains at least statements of the Seller about receipt of the Order and its acceptance for execution and confirmation of conclusion of the Sales Agreement. At the moment of receipt by the Customer of the above email, the Sales Agreement between the Customer and the Seller is concluded.

3.4 Theconsolidation, protection and making available to the Customer the content of the concluded Sales Agreement takes place by (1) making these Regulations available on the website of the Online Shop and (2) sending the Customer the email, referred to in point 3.3. of these Regulations. 3.3 of the Regulations. The content of the Sales Agreement is additionally recorded and secured in the IT system of the Seller's Internet Shop.

4. METHODS AND TERMS OF PAYMENT FOR THE PRODUCT

4.1The Seller shall make available to the Buyer the following methods of payment for a Sales Agreement:

  • Cash-on-delivery payment on delivery.
  • Payment in cash on delivery.
  • Payment by bank transfer to the bank account of the Seller.
  • Electronic payment via Przelewy24.pl.

4.2 Payment term:

  • If the Customer chooses wire transfer or electronic payment, the Customer is obliged to make payment within 7 calendar days of the conclusion of the Sales Agreement.
  • In case the Customer chooses cash on delivery or cash on delivery in person, the Customer is obliged to make payment on delivery.

5. COSTS, WAYS AND DATE OF DELIVERY AND COLLECTION OF THE PRODUCT

5.1The Product delivery is available in the Republic of Poland.

5.2.Delivery of the Product to the Client is chargeable, unless the Sales Agreement provides otherwise. The Product delivery costs (including transport, delivery and postal fees) are indicated to the Customer during the Order placement process, including also at the moment of expressing the Customer's will to be bound by the Sales Agreement.

5.3Personal collection of the Product by the Customer is free of charge.

5.4The Seller makes available to the Customer the following methods of delivery or collection of the Product:

  • Courier delivery.
  • Personal collection from the Seller's warehouse located in Wieluń, after prior confirmation of the date.

5.5 The deadline for delivery of the Product to the Customer is up to 16 weeks, unless a different deadline is specified in the description of the Product or during the Order placement process. In the case of Products with different delivery times, the delivery time is the longest specified time. The start of the Product delivery period to the Customer is calculated as follows:

  • If the Customer chooses the method of payment by transfer or electronic payment - from the date of crediting the bank account or settlement account of the Seller.
  • In case of choosing by the Customer the cash on delivery method of payment - from the date of the conclusion of the Sales Agreement.

5.6 Deadline for Product readiness for collection by the Customer - in the case of choosing by the Customerto collect the Product personally, the Product will be ready for collection by the Customer within 15 weeks, unless a shorter deadline is given in the Product description or during placing the Order. In the case of Products with different deadlines for readiness for collection, the deadline for readiness for collection is the longest specified deadline, which however cannot exceed 15 weeks. The start of the deadline for the Product to be ready for collection by the Client is counted as follows:

  • If the Customer chooses the method of payment by bank transfer or electronic payment - from the date of crediting the bank account or settlement account of the Seller.
  • In case of choosing by the Client the cash on delivery method - from the date of the conclusion of the Sales Agreement.

6. PRODUCT COMPLAINTS

6.1The basis and scope of liability of the Seller to the Customer, if the sold Product has a physical or legal defect (warranty) are determined by generally applicable law, in particular, the Civil Code.

6.2The Seller is obliged to deliver the Product without defects to the Customer.

6.3A complaint can be submitted by the Customer for example:

  • in writing;
  • in electronic form via e-mail

6.4The Customer is recommended to provide in the description of the complaint: (1) information and circumstances concerning the subject matter of the complaint, in particular the type and date of occurrence of the defect; (2) request for a method of bringing the Product into conformity with the Sales Agreement or a declaration of price reduction or withdrawal from the Sales Agreement; and (3) contact details of the complainant - this will facilitate and accelerate the processing of the complaint by the Seller. The requirements specified in the preceding sentence are only a recommendation and shall not affect the effectiveness of complaints submitted with the omission of the recommended description of the complaint.

6.5 The Seller within 14 days shall respond to:

  1. declaration of a request to reduce the price;
  2. statement of withdrawal from the contract;
  3. request to replace the item with a defect-free item;
  4. request for defect removal.

Otherwise it shall be deemed that he considered reasonable statement or demand of the Consumer.

6.6The Seller shall respond to the Customer's complaint immediately, no later than within 14 calendar days from the date of its submission. Failure of the Seller to respond within the above period means that the Seller considered the complaint as justified.

6.7The Buyer, who exercises the rights under warranty, is obliged to deliver the defective Product at the expense of the Seller to the address: Warsaw (02-769), 257/86 Pulawska St., or any other address agreed with the Seller. If due to the type of the Product or the way it is installed, delivering the Product by the Customer would be too difficult, the Customer is obliged to make the Product available to the Seller at the place where the Product is located.

6.8The differences in the tint of the colour of fabric, leather, eco-leather, wood or metal elements, which are the result of differently set parameters of the monitor or graphics card, do not constitute the basis for the complaint. Additionally, the Seller reserves the possibility of structural and colour differences in materials coming from different batches and differences between the offered sample book and the material obtained in production. These differences result from the natural process of dyeing fabrics and leather and are independent of the Seller.

7. OUT-OF-COURT COMPLAINT HANDLING AND CLAIM INVESTIGATION PROCEDURES AND RULES OF ACCESS TO THOSE PROCEDURES

7.1Detailed information about the possibility of using by the Customer who is a consumer out-of-court complaint handling and claims investigation procedures and the rules of access to these procedures are available at the offices and on the websites of district (city) consumer ombudsmen, social organizations whose statutory tasks include consumer protection and Provincial Inspectorates of Trade Inspection.

8. RIGHT OF WITHDRAWAL

8.1 Aconsumer who has entered into a remote agreement, may within 14 calendar days withdraw from it without giving any reason and without bearing any costs, except for the costs set out in point. 8.8 of the Regulations. In order to meet the deadline it is enough to send the statement before its expiry. A declaration of withdrawal from a contract may be made, for example:

  • in writing;
  • electronically via e-mail;

8.2A sample form of withdrawal from the contract is included in Annex No. 2 to the Consumer Rights Act and is additionally available in point. 11 of these Terms and Conditions and on the Shop's website under "Returns and complaints". The consumer may use the sample form, but it is not mandatory.

8.3The period for withdrawal from the contract shall begin:

  • for the contract, in the performance of which the Seller issues the Product, being obliged to transfer its ownership (e.g. Sales Agreement) - from taking possession of the Product by the consumer or a third party indicated by him other than the carrier, and in the case of a contract, which: (1) includes many Products that are delivered separately, in batches or in parts - from taking possession of the last Product, batch or part, or (2) consists in the regular supply of Products for a fixed period - from taking possession of the first Product;
  • For other contracts - from the date of conclusion of the contract.

8.4In the case of withdrawal from the remote agreement, the agreement is considered as not concluded.

8.5 TheSeller shall immediately, no later than within 14 calendar days from the date of receipt of the consumer's statement of withdrawal, return to the consumer all payments made by him, including the costs of delivery of the Product (with the exception of additional costs arising from the chosen by the Customer delivery method other than the cheapest ordinary delivery method available at the Online Store). The Seller shall refund the payment using the same method of payment used by the Consumer, unless the Consumer has explicitly agreed to a different method of refund, which does not involve any costs for him. If the Seller has not offered to collect the Product from the consumer himself, the Seller may withhold the reimbursement of payments received from the consumer until the Product is received back or the consumer provides proof of its return, whichever event occurs first.

8.6The Consumer shall be obliged to immediately, no later than within 14 calendar days from the date of withdrawal, return the Product to the Seller or provide it to a person authorized by the Seller to receive it, unless the Seller offered to collect the Product itself. To meet the deadline it is sufficient to return the Product before its expiry. The Consumer may return the Product to the following address: Warsaw(02-769), ul. Pulawska 257/86 or any other address agreed with the Seller.

8.7The Consumer is responsible for any diminution in the value of the Product resulting from the use of it in a manner beyond the necessary to ascertain the nature, characteristics and functioning of the Product.

8.8.Possible costs associated with the withdrawal from the agreement by the consumer, which must be borne by the consumer:

  • If the consumer has chosen a method of delivery of the Product other than the cheapest ordinary method of delivery available at the Online Shop, the Seller is not obliged to reimburse the consumer for the additional costs incurred by him.
  • The consumer bears the direct costs of returning the Product.
  • In the case of a Product which is a service, the performance of which - at the express request of the consumer - began before the expiry of the deadline for withdrawal from the contract, the consumer who exercises the right of withdrawal after making such a request, is obliged to pay for the services performed until the withdrawal from the contract. The amount to be paid shall be calculated in proportion to what has been provided, taking into account the price or remuneration agreed in the contract. If the price or remuneration is excessive, the basis for calculating this amount is the market value of the performance.

8.9 Theright of withdrawal from the agreement concluded at a distance shall not be granted to the consumer in relation to the agreements:

  • (1) for the provision of services, if the Seller has fully performed the service with the express consent of the consumer, who has been informed before the provision, that after the fulfillment of performance by the Seller will lose the right of withdrawal; (2) in which the price or remuneration depends on fluctuations in the financial market, over which the Seller does not exercise control, and which may occur before the expiry of the deadline for withdrawal; (3) in which the subject of the performance is a non-refabricated product, produced to consumer specification or serving to meet his individual needs; (4) in which the subject of the performance is a product that deteriorates rapidly or has a short shelf life; (5) in which the subject matter of the performance is a Product delivered in a sealed package which cannot be returned after opening the package for health protection or hygienic reasons, if the package has been opened after delivery; (6) in which the subject matter of the performance are Products, which after delivery, due to their nature, are inseparably connected with other things (7) in which the subject of performance are alcoholic beverages, the price of which has been agreed upon at the conclusion of the Sales Agreement, and the delivery of which may take place only after 30 days and the value of which depends on market fluctuations, over which the Seller has no control; (8) in which the consumer explicitly requested that the Seller came to him in order to perform urgent repair or maintenance; if the Seller provides in addition other services than those which the consumer requested to perform, or provides Products other than spare parts necessary to perform repair or maintenance, the consumer has the right to withdraw from the agreement with regard to additional services or Products (9) in which the subject matter of the performance is a sound or visual recording or computer software supplied in a sealed package, if the package has been opened after delivery; (10) for the supply of newspapers, periodicals or magazines, except for a subscription agreement; (11) concluded by public auction; (12) for the provision of accommodation, other than for residential purpose, carriage of goods, car rental, catering, services related to leisure, entertainment, sports or cultural events, if the contract specifies the date or period of service (13) for the supply of digital content which is not recorded on a tangible medium, if the performance has begun with the consumer's express consent before the expiry of the withdrawal period and after the Seller has informed him about the loss of the right to withdraw from the contract.

9. PROVISIONS CONCERNING ENTREPRENEURS

9.1This section of the Terms and Conditions and the provisions contained therein shall apply only to Clients and Customers who are not consumers.

9.2The Seller shall have the right to withdraw from the Sales Agreement concluded with a Customer who is not a consumer within 14 calendar days from the date of its conclusion. Withdrawal from the Sales Agreement in this case can be made without giving any reason and does not give rise to any claims against the Seller to the Customer who is not a consumer.

9.3As far as the Clients who are not consumers are concerned, the Seller shall have the right to limit the available payment methods, including the requirement to make the payment in full or in part in advance, regardless of the payment method chosen by the Client and the fact of concluding a Sales Agreement.

9.4At the moment of handing over the Product by the Seller to the carrier, the benefits and burdens associated with the Product as well as the danger of accidental loss or damage to the Product shall pass to the Customer who is not a consumer. In this case, the Seller is not responsible for the loss, diminution or damage to the Product arising from its adoption for transportation until its release to the Customer and for the delay in transportation of the consignment.

9.5If the Product is sent to the Customer by a carrier, the Customer who is not a consumer shall be obliged to examine the consignment at the time and in the manner customary for consignments of this type. If he finds that during transport there was a defect or damage to the Product, he is obliged to make all necessary steps to determine the liability of the carrier.

9.6Pursuant to Art. 558 § 1 of the Civil Code, the Seller's liability under warranty for the Product towards the Customer who is not a consumer is excluded.

9.7In the case of the Customer who is not a consumer, the Service Provider may terminate the contract for the provision of Electronic Services with immediate effect and without giving reasons by sending the appropriate statement to the Customer.

9.8 Theliability of the Service Provider/Seller to the Customer/Client who is not a consumer, regardless of its legal basis, shall be limited - both for a single claim and for all claims in total - to the amount of the price paid and delivery costs under the Sales Agreement, but no more than one thousand PLN. The Service Provider / Seller shall be liable to the Customer / Client who is not a consumer only for the typical damage foreseeable at the time of conclusion of the contract and shall not be liable for lost profits in relation to the Customer / Client who is not a consumer.

9.9Any disputes arising between the Seller / Service Provider and the Customer / Client who is not a consumer are subject to the competent court for the seat of the Seller / Service Provider.

10. OPINIONS IN THE INTERNET SHOP

10.1 TheOnline Store Customer has the opportunity to voluntarily and free of charge issue an opinion on purchases made at the Online Store. The subject of the opinion can also be an assessment, photo or review of the purchased product at the Online Store.

10.2The Seller after purchases made at the Online Store sends an email to the Customer with a request for issuing an opinion and a link to the online form allowing it to be issued - the online form allows you to answer questions about purchases made by the Seller, their assessment, adding your own description regarding the opinion and a photo of the purchased product. In the absence of an opinion after the receipt of the first email, the Seller may re-send a message asking for an opinion.

10.3Opinion can be issued only by the Customer who made purchases at the Online Store of the Seller.

10.4Opinion cannot be used by the Customer to unlawful activities, in particular, to act as an act of unfair competition to the Seller, or actions that violate personal rights, intellectual property rights or other rights of the Seller or third parties.

10.5Opinion can be issued only to actually purchased products at the Seller's online store. It is prohibited to enter into fictitious / apparent sales contracts to issue an opinion.

11. FINAL PROVISIONS

11.1Contracts concluded through the Online Store are concluded in Polish.

11.2Change of Regulations:

  • The Service Provider reserves the right to make changes to the Terms and Conditions for important reasons, that is: changes in legislation; changes in methods of payment and delivery - to the extent that these changes affect the implementation of the provisions of these Terms and Conditions.
  • In case of conclusion of continuous contracts on the basis of these Regulations (e.g. provision of Electronic Services - Account), the amended Regulations shall be binding upon the Service Recipient, if the requirements specified in Article 384 and 384[1] of the Civil Code have been met, i.e. the Service Recipient has been correctly notified of the changes and has not terminated the contract within 14 calendar days from the date of notification. In the event that the amendment of the Terms of Use results in the introduction of any new fees or an increase in current fees, the Customer who is a consumer has the right to withdraw from the contract.
  • In the case of conclusion of contracts on the basis of these Terms and Conditions other than continuous contracts (e.g. Sales Agreement), amendments to the Terms and Conditions shall in no way affect the rights acquired by the Customer / Client who is a consumer before the effective date of changes to the Terms and Conditions, in particular the changes to the Terms and Conditions shall not affect Orders already placed or placed and Sales Agreements concluded, executed or performed.

11.3In matters not covered by these Regulations, generally applicable provisions of Polish law shall apply, in particular: Civil Code; Act on rendering electronic services of 18 July 2002. (Journal of Laws 2002 No. 144, item 1204 as amended); for Sales Agreements concluded with Customers who are consumers - the provisions of the Consumer Rights Act of 30 May 2014. (Journal of Laws 2014, item 827 as amended); and other relevant provisions of generally applicable law.

12. MODEL WITHDRAWAL FORM

(ANNEX NUMBER 2 TO THE CONSUMER RIGHTS ACT)


Model withdrawal form
(this form should be completed and returned only if you wish to withdraw from the contract)

- Addressee:

Eye on Design K.Żebrowska P.Horyza spółka cywilna with registered office in Warsaw (02-769), 257/86 Pulawska Str., NIP: 5213894685, Regon: 385855520

- I/We(*) hereby give notice(*) of my/our withdrawal from the contract of sale of the following items(*) the contract for delivery of the following items(*) the contract for workmanship of the following items(*)/the provision of the following service(*)

- Date of conclusion of the contract(*)/of receipt(*)

- First and last name of consumer(s)

- Address of consumer(s)

- Signature of consumer(s) (only if this form is notified on paper)

- Date

(*) Delete where not applicable.