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General Conditions of Sale (GTC) applicable for orders made on the site www.uzs.fr

ARTICLE 1. PURPOSE AND SCOPE OF THE GENERAL CONDITIONS OF SALE

These general conditions of sale (hereinafter referred to as "GTC"), apply to all orders placed by consumer customers, on our website www.uzs.fr (hereinafter referred to as the "website"), shoes and other items marketed on our site by the company "UZS" under the brand "UZS" (hereinafter referred to as the product(s)).

Contact details of the company "UZS" hereinafter referred to as "the Seller": Company "UZS", Limited Liability Company with capital of 5,000 Euros, whose registered office is 6 506, Chemin du Vinigre in SAINT QUENTIN LA POTERIE (30700 ), registered in the Trade and Companies Register of NIMES under number 839 951 019 - SIRET number: 839 951 019 00018 -  Code APE 1520Z - Manufacture of shoes - Intra-community VAT number FR67839951019 – Contact details of the Seller's after-sales service:  UZS, ZAC du Queyrol- Route D'Aigaliers-SERVIERS ET LABAUME (30700) - :_cc781905-5cde-3194- bb3b-136bad5cf58d_ - E-mail: eleveur@uzs.fr - Website:www.uzs.fr– After-sales service hours:   Monday to Friday from 9 a.m. to 8 p.m.

Contact details of the consumer customer hereinafter referred to as "the Consumer":  these general conditions of sale apply to all orders placed by consumer customers as defined in the introductory article of the Code consumption, consumer customers with a delivery address located in mainland France and having provided their contact details on our website when placing their order: E-mail address for order confirmation, First name and family name, address residence, address of the place of delivery with postal code and city, and telephone number of the Customer.

On our website, the contracts are exclusively presented and concluded in French. The consumer Customer acknowledges having read, prior to sending his order, these general conditions of sale and having received the communication by the Seller of all the information referred to in article L 221-5 of the Code of the Consumption, in a readable and understandable manner. The fact for the consumer to validate his order on our website is worth acceptance and adhesion by the latter and without reserve of the present general conditions of Sale, the order and the GTC constituting the distance sale contract concluded electronically between the Seller and the Consumer  (hereinafter referred to as "the contract").

These GCS are subject to revision at any time by the Seller and without notice. However, orders are governed by the T&Cs in force at the time the order is placed by the Customer.

These T&Cs expressly exclude the legal contingency regime provided for in article 1195 of the Civil Code. The Seller and the Customer therefore each waive the right to avail themselves of the provisions of article 1195 of the Civil Code and the contingency regime provided for therein.

This version of the T&Cs is applicable from May 1, 2019.

ARTICLE 2. PLACING OF ORDER

The Customer selects on the website "www.uzs.fr" the item(s) he wishes to order, according to the following methods:

  • Selection of the product(s) desired by the Customer on our site, with a choice of the Size (drop-down menu allowing the size to be selected), the Quantity ordered of the product (Quantity to be entered by the Customer), and the prices offered, in filling in a "CART" (Click by the Customer on the "Add to Cart" tab),

  • Consultation by the Customer of his basket in order to check or, if necessary, modify his selection, check the price of each product and the total amount of his selection,

  • Validation of the basket including the summary of the order (Summary: Product ordered (model) with the size, Unit Price, Quantity ordered, Total Price Excluding Taxes, applicable VAT, Total Price including VAT),

  • Step of the first click "Order",

  • Then Online creation of a Customer account with the company "UZS" with information by the Customer of the following identity elements: E-mail address for order confirmation, First name and family name, home address, address of the place of delivery with postal code and city, and telephone number of the Customer,   or identification of the Customer in his Customer account by means of a secure form (if already a Customer);

  • After this identification of the Customer, Choice of the Delivery address and the billing address, it being specified that the delivery costs are free. The delivery times will be indicated to the Customer when the Customer chooses the delivery address,

  • Validation of these general conditions by a checkbox "I have read the general conditions of sale and I adhere to them without reservation", after reading by the Customer of the said general conditions appearing in a drop-down banner, and step of the second click "Order »,

  • Last step: choice of payment method: by credit card only (CB, VISA or MASTERCARD, excluding "ELECTRON" cards from the VISA network and "MAESTRO" cards from the MASTERCARD network), with the following information to be provided: bank card number, its expiry date and the last three digits appearing on the back of it, near its signature (called "visual cryptogram" or "CVV code"), then click on the "I confirm my order", which definitively registers the Customer's order.

Consequently, the registration of an order on the Seller's site is made when the Customer accepts these General Conditions by ticking the box provided for this purpose and definitively registers his order by paying the price.

The Customer has the possibility to check the details of his order, its total price and to correct any errors before confirming his acceptance (article 1127-2 of the Civil Code). This validation implies acceptance of all of these General Conditions and constitutes proof of the sales contract. It is therefore up to the Customer to verify the accuracy of the order and to immediately report any errors.

The sale of the product(s) will be confirmed by the Seller by sending the Customer confirmation of the acceptance of the order by the Seller, by e-mail (provided by the Customer at the time of his order on the website) - and after receipt by the latter of the full agreed price.

This ordering does not exclude the possibility:

  • For the consumer, to assert his right of withdrawal or to implement the seller's guarantees, provided for below,

  • For the seller, to cancel the sale and reimburse the consumer, in the cases specified in articles 3b, 5a and 8 stipulated below,

  •   The seller reserves the right to cancel any order from a customer with whom there is a dispute relating to the payment of a previous order.

In case of return of your parcel from Colissimo for an error of address on your part indicated during your placing of order, a reshipping fee of 10€ will be requested from you in order to reship your order again.

ARTICLE 3. AVAILABILITY OF PRODUCTS
  1. The products visible on the website are offered for sale while stocks last. The presence of a product on the website, at a given time, does not presume its availability at a later time.

 

  1. The possibility for the consumer to confirm the order of a product is likely to presume its availability in relation to its theoretical stock. However, differences between theoretical stocks and physical stocks may exceptionally lead to the unavailability of a product ordered. If this case arises, the seller's after-sales service will contact the consumer directly to inform him of this unavailability and indicate to him, if necessary, the date on which an identical product will be available again. The consumer will be entitled to cancel his order if he does not accept the new date of availability of the product communicated by the Seller. In any case, the Consumer will remain free to accept any proposal from the after-sales service in the event of unavailability of the product ordered.

ARTICLE 4. PRICE – TERMS AND CONDITIONS OF PAYMENT
  1. The prices invoiced to the customer are those in force on the day the order is registered, after deduction, where applicable, of all discounts, discounts and rebates that may be applicable to the order, and which will appear expressly in the summary of the ordered.

 

The prices appearing on our site are the final prices and include all taxes (TTC) at the legal rate in force on the day the order is placed.

 

For Metropolitan France the delivery costs are offered.

 

  1. The prices indicated may be subject to variations depending on exceptional events beyond the control of the seller. In this respect, the seller reserves the right to modify its prices at any time, but in any case, the products will be invoiced on the basis of the prices in force at the time of the registration of the orders and subject to the availability of the products.

 

  1. The transfer of ownership of the products sold to the benefit of the Customer is subject to full payment of the price by the latter.

 

  1. Payment is made in cash, without discount, by debiting the consumer's bank card, a debit which is made when the products are dispatched by the Seller.

 

The bank cards approved by the banking establishment managing the payments made via the website are:

  • Bank cards on which the “CB” mark appears,

  • "CB" approved cards, i.e. cards bearing only the marks
    "VISA" or "MASTERCARD" (excluding foreign "ELECTRON" cards from the VISA network and foreign "MAESTRO" cards from the MASTERCARD network).

The Consumer expressly agrees to receive invoices and any credit note invoices in electronic form in PDF format.

ARTICLE 5. VERIFICATION AND SECURITY OF PAYMENTS

a) The seller checks all orders that have been validated on its website. These checks are intended to protect against possible fraud. To this end, the seller may restrict or cancel certain sales presenting a potential or proven risk, in particular due to payment incidents or fraud already observed against a bank card and/or its holder.

b) In order to ensure payment security, the website uses a secure payment service. This service incorporates the SSL security standard (Secure Socket Layer  "SECURE SHOPPING"): Confidential data (the name of the card owner, the 16-digit credit card number and the date expiration, the last three digits appearing on the back of it, close to its signature (called "visual cryptogram" or "CVV code") are directly transmitted encrypted on the bank's server without transiting on the physical media of the vendor server.

After the consumer has confirmed his order, a payment request is routed in real time to the secure electronic payment manager, which sends an authorization request to the bank card network. The telepayment manager issues the consumer an electronic certificate which will serve as proof of the amount and date of the transaction.

 


ARTICLE 6. TERMS OF DELIVERY OF PRODUCTS AND DELIVERY TIMES
  1. All our products are delivered by "colissimo - TRACKING" which is provided by "LA POSTE".
     

  2. The seller undertakes to deliver the order to the Customer at the latest within Seven (7) working days following the date of registration of the order. In the event of a stock shortage, any order may be subject to partial delivery and additional deliveries.
     

  3. For Metropolitan France, delivery costs are offered to the consumer.
     

  4. The products ordered travel at the risk and peril of the Seller. The risks of loss and deterioration of these will be transferred to the consumer when the latter takes physical possession of them, that is to say at the time of receipt of the delivery.
     

  5. All products on sale will be delivered free of charge by the Colissimo service. For any request to return a product on sale, the customer will be fully responsible for paying all costs related to this product return.

 

To safeguard his rights, the consumer must, at the time of his (their) receipt of the product(s):

 

- open the package(s) in the presence of the carrier,

- check immediately if his order is complete and corresponds to the products ordered and if the goods are damaged,

- any complaints must be expressly mentioned to the carrier on the transport documents and/or acknowledgment of receipt, or must be addressed without delay to the transport company. The Consumer must also inform the Seller's after-sales service of these same complaints within 24 hours of receipt of the products, at the following email address: eleveur@uzs.fr

 

 
ARTICLE 7. SELLER'S RESPONSIBILITY


The seller cannot be held responsible for the non-performance or poor performance of the contract concluded with the consumer if this is attributable to:


•     Either to the consumer,


•     Either the unpredictable and insurmountable event of a third party unrelated to the provision of the services provided for in the contract (for example: logistical problems at the level of the postal services responsible for delivery of the products, postal service strikes, warehouse blockages and road blockages preventing the delivery of the products, problems in the means of transport and/or communication),


•     Either in a case of force majeure: sudden, unforeseeable, irresistible event external to the parties, such as without this list being exhaustive: war, attack, riot, fire, bad weather, storms, floods, drought, strikes, accidents, shortages, disruption of transport, road blockades, blockades of warehouses, disturbances of public order, computer hacking, breakdown of internet networks, interruption of the supply of energy, raw materials, etc.

 


ARTICLE 8. CONSUMER CUSTOMER'S LEGAL RIGHT OF WITHDRAWAL PROVIDED FOR IN ARTICLE L221-18 OF THE CONSUMER CODE

The consumer has a period of fourteen (14) days to exercise vis-à-vis his Seller his right of withdrawal from his contract concluded at a distance without having to justify his decision or to bear any costs other than those provided for in the Articles L. 221-23 to L. 221-25 of the Consumer Code.

This withdrawal period expires fourteen days after the day of receipt of the product by the consumer or by a third party, other than the carrier, designated by the consumer to receive the product. In the case of an order relating to several goods delivered separately, the period runs from the receipt of the last good.

The consumer exercises his right of withdrawal by informing the Seller of his decision to withdraw by sending, by post or by e-mail, before the expiry of the period provided for above of 14 days, the withdrawal form whose model is provided at the end of these general conditions of sale, and which is also present in the package containing the order, or any other declaration, unambiguous, expressing its desire to retract.

If this right of withdrawal is used, the Seller will immediately notify the Consumer Customer by e-mail of the acknowledgment of receipt of this right of withdrawal.

In any case, in the context of the return of the product(s), the Consumer may use the return label attached to his order or which the consumer may edit from his Customer account on the Seller's website.

Exception to the application of this right of withdrawal:

In accordance with paragraph 5 of article L 221-28 of the Consumer Code, the right of withdrawal cannot be exercised by the Consumer Customer in the case of products which have been unsealed by the consumer after delivery and which may be returned for reasons of hygiene or health protection.

This right of withdrawal gives the consumer the right to make mistakes and to try the product. However, the consumer's liability will be engaged if he exercises this right in an abusive manner. This abuse will be constituted if manipulations other than those necessary to establish the nature, characteristics and proper functioning of the product - manipulations other than those which would be allowed to the consumer for a test of these products in store, cause the deterioration of the product.

This right of return can only be accepted for complete, new products, in their original condition and packaging (shoe box, cardboard around the shoe box, shoe protection paper, clothing packaging, accessories, manual, etc.) with a copy of the purchase invoice, and the labels attached to the product. Items returned incomplete, damaged, damaged or soiled by the consumer are not taken back, and will be sent back to the consumer at his expense (compulsory prior payment of return costs).

The company “UZS” reserves the right to invoice the consumer for the damaged packaging (box or bag) which has been returned to it, for an amount of 10 Euros including tax.

The consumer must return the product(s) to the Seller, without undue delay and, at the latest, within fourteen days of the communication of his decision to withdraw.

The consumer will only bear the direct costs of returning the product(s), unless the Seller agrees to bear them. The consumer is required to use the same means of shipment as that used by the seller, as well as packaging ensuring the protection of the product(s) and its (their) original box._cc781905-5cde -3194-bb3b-136bad5cf58d_ Otherwise, the seller may oppose such a breach to the consumer.

The Seller undertakes to reimburse the consumer for all sums paid (price including VAT of the products), without undue delay and at the latest until recovery of the goods by the Seller. The Seller will make this refund using the same means of payment as that used by the consumer for the initial transaction.

When purchasing discounted products on the site, the return shipping costs are your responsibility.

The postal address for returning the products is as follows:

UZS,
QUEYROL ZAC

Road to Aigaliers
30700 SERVIERS AND LABAUME

Any package sent to another address will be refused.

 

The Seller, whose contact details appear at the top of these GCS, is liable for defects in the conformity of the product with the contract for the benefit of its Consumer Customers under the conditions of article L. 217-4 and following of the Consumer Code and defects hidden from the thing sold under the conditions provided for in articles 1641 and following of the civil code. When the Customer acts as a legal guarantee of conformity, the latter: - has a period of two years from the delivery of the goods to act; - can choose between the repair or the replacement of the good, subject to the conditions of cost envisaged by the article L. 217-9 of the code of consumption; - is exempted from providing proof of the existence of the lack of conformity of the goods during the twenty-four months following the delivery of the goods. Furthermore, the Customer may decide to implement the guarantee against hidden defects of the thing sold within the meaning of article 1641 of the Civil Code and the Customer may in this case choose between the resolution of the sale or a reduction of the sale price in accordance with article 1644 of the civil code.

 

ARTICLE 9. LEGAL GUARANTEES AND EXCLUSIONS OF GUARANTEES

 

The Seller, whose contact details appear at the top of these GCS, is liable for defects in the conformity of the product with the contract for the benefit of its Consumer Customers under the conditions of article L. 217-4 and following of the Consumer Code and defects hidden from the thing sold under the conditions provided for in articles 1641 and following of the civil code. When the Customer acts as a legal guarantee of conformity, the latter: - has a period of two years from the delivery of the goods to act; - can choose between the repair or the replacement of the good, subject to the conditions of cost envisaged by the article L. 217-9 of the code of consumption; - is exempted from providing proof of the existence of the lack of conformity of the goods during the twenty-four months following the delivery of the goods. Furthermore, the Customer may decide to implement the guarantee against hidden defects of the thing sold within the meaning of article 1641 of the Civil Code and the Customer may in this case choose between the resolution of the sale or a reduction of the sale price in accordance with article 1644 of the civil code.

 

 

In accordance with paragraph 4 of article L 217-15 of the Consumer Code, the articles
L. 217-4, L. 217-5, L. 217-12, L. 217-16 of the said code as well as article 1641 and the first paragraph of article 1648 of the civil code are fully transcribed below: Articles of the Consumer Code: Article L217-4: The seller delivers goods that comply with the contract and is liable for any lack of conformity existing at the time of delivery. He also responds to defects of conformity resulting from the packaging, the assembly instructions or the installation when this has been charged to him by the contract or has been carried out under his responsibility. Article L217-5: The good is in conformity with the contract: 1° If it is suitable for the use usually expected of a similar good and, if necessary: - if it corresponds to the description given by the seller and has the qualities that the latter a presented to the buyer in the form of a sample or model; - if it has the qualities that a buyer can legitimately expect given the public statements made by the seller, by the producer or by his representative, in particular in the advertising or labeling; 2° Or if it has the characteristics defined by mutual agreement by the parties or is suitable for any special use sought by the buyer, brought to the seller's attention and which the latter has accepted. Article L217-12: The action resulting from the lack of conformity is prescribed by two years from the delivery of the goods. Article 1641 of the Civil Code: The seller is bound by the guarantee on account of the hidden defects of the thing sold which render it unfit for the use for which it is intended, or which reduce this use so much that the buyer would not have it. acquired, or would have given only a lesser price, if he had known them. Article 1648 of the Civil Code (1st paragraph): The action resulting from redhibitory defects must be brought by the purchaser within two years from the discovery of the defect.

 

In any case :

has). The seller guarantees that the products marketed on its website comply with the standards in force, that they present, under normal conditions of use or other reasonably foreseeable conditions, the safety that any consumer can expect and that they do not harm people's health.

b) The seller undertakes to deliver products suitable for “standard” walking use, excluding any sporting use or on unsuitable grounds. The consumer will not be able to assert a defect of the product if this results from an inappropriate use and not guaranteed by the seller.

Excluded from the warranty are: all incidents relating to fortuitous events or force majeure, normal wear and tear, improper use, negligence, lack of maintenance or monitoring of the products, abnormal use products by the Customer and perceived as such by the Seller.

c) The seller undertakes to deliver products that conform to the descriptions and photographs on the website. However, the technical processes used may cause color variations between the original models and their photographic reproduction or their visual reproduction to the human eye depending on the screen of the computer, tablet or telephone used by the consumer. Similarly, the color baths used for the manufacture of sneakers can cause the colors of the models to vary marginally. Consequently, the colors of the models presented on the website are purely indicative and not contractual.

d) The seller undertakes to deliver products that conform to those ordered by the consumer, without substituting other products.

The aforementioned guarantees can be exercised by the Consumer by sending a request to the after-sales service, the contact details of which appear in article 1 of these general conditions.

 

In the event of acceptance by the Seller of the Consumer's request, the consumer will be required to follow the return procedures indicated by the Seller's after-sales service.

 

In the event of a lack of conformity, the Consumer will have the choice between repairing the product or replacing it (within the limits of available stocks). However, the seller may not proceed according to the choice of the buyer if this choice entails a manifestly disproportionate cost with regard to the other method, taking into account the value of the good or the importance of the defect. He is then required to proceed, unless this is impossible, according to the method not chosen by the buyer.

 

If the repair or replacement of the product is impossible, the Customer may return the goods and have the price refunded or keep the goods and have part of the price refunded.

 
The same option is open to him if the solution requested, proposed or agreed pursuant to Article L. 217-9 of the Consumer Code cannot be implemented within one month of the buyer's complaint. ; or if this solution cannot be without major inconvenience for him given the nature of the property and the use he is looking for.

 

However, the resolution of the sale cannot be pronounced if the lack of conformity is minor.

In any event, the after-sales service may make the replacement of the product or its repair or refund subject to the return of the original product. In which case, in order to allow the rapid processing of his request, the consumer must mention, on the packaging of the return package, the return number, obtained from the after-sales service. Whatever solution is chosen, the consumer will not bear any costs.

ARTICLE 10. IDENTIFICATION OF THE CONSUMER & CONFIDENTIALITY OF HIS PERSONAL DATA

The consumer who has already made a purchase on the website can choose an identifier and a password allowing him, during subsequent orders, to be recognized by the website as being already a customer and, consequently, not to having to complete the forms again prior to placing the order. The username and password enjoyed by the consumer are strictly confidential and personal. In the event that the consumer should lose or forget them, it is his responsibility to notify the seller as soon as possible, who will issue new ones to him; which will automatically replace the old ones. In order to facilitate the identification of the consumer by the simultaneous provision of the e-mail address and the password, the consumer expressly authorizes the seller to deposit on the hard disk of the consumer a file called "cookie", whose sole purpose is to facilitate such identification.

In accordance with the Data Protection Act of January 6, 1978, the Customer has a right of access, rectification and opposition to the personal data which concerns him, and which has been collected by the Seller for the purpose of processing orders. The Customer may exercise these rights by writing directly to the Seller whose contact details appear in article 1 hereof.

The Seller undertakes to protect information relating to the privacy of its Customers in compliance with the aforementioned law known as "Informatique et Libertés" and Regulation No. 2016/679 of the European Parliament and Council of April 27, 2016 relating to the protection of individuals with regard to the processing of personal data and the free movement of such data (“GDPR”).

In accordance with this regulation, the Customer has the following rights on his personal data: right of access, right of rectification, right of opposition, right to be forgotten, right to limit processing, right to portability. The Customer may, for legitimate reasons relating to his particular situation, oppose the processing of data concerning him. The Customer may also define directives relating to the storage, erasure and communication of his personal data after his death.

ARTICLE 11. RECEIPT OF NEWSLETTERS AND COMMERCIAL OFFERS FROM THE SELLER, BY E-MAIL

The consumer will regularly receive, by e-mail, newsletters and commercial offers from the seller, insofar as he has expressly authorized the seller beforehand. The consumer grants this authorization by ticking the appropriate box, after validation of his “basket”. The seller undertakes not to transfer the consumer's contact details for the purposes of commercial prospecting by other sellers. However, the seller may, where appropriate, subcontract the processing related to the sending of these e-mails, in whole or in part.

Each e-mail received will provide the consumer with the possibility of stopping this e-mail distribution, in particular by "clicking" on a "link" provided for this purpose and located at the bottom of the e-mails. The transmission of the consumer's request can be carried out simply and free of charge (apart from those possibly linked to the transmission of his refusal by his internet access provider, or by his telephone operator, or by the postal services).

 

 


ARTICLE 12. INTELLECTUAL PROPERTY

Unless otherwise stated, the seller is the holder of all rights, in particular the brand "ELEVEURS DE SNEAKERS WWW.UZS.FR UZS" relating to the texts, products and illustrations, of any kind, present on the website. In the absence of prior written authorization from the seller, any use or any total or partial reproduction of these elements constitutes counterfeiting and is punishable by the competent courts.

ARTICLE 13. APPLICABLE LAW.

These T&Cs are subject to French law and French courts.

If by extraordinary, one of the clauses of these general conditions turns out to be null, it would then be deemed unwritten and would not entail the nullity of the other provisions of these general conditions.

In accordance with Article L 612-1 of the Consumer Code, the “Consumer has the right to have free recourse to a consumer mediator with a view to the amicable resolution of the dispute between him and a professional”. Consequently, if a disagreement persists between the Seller and the Consumer Customer, the latter may contact the Mediator defined below who will attempt to bring the Parties together with a view to an amicable solution: FEVAD e-commerce mediator (Fédération du e-commerce and distance selling) whose contact details are as follows: 60 Rue La Boétie – 75008 Paris – https://www.mediateurfevad.fr.

After prior written action by consumers vis-à-vis the seller, the Mediator's Service may be contacted for any consumer dispute whose settlement has not been successful.

To find out how to refer to the Mediator, click here. https://www.mediateurfevad.fr/index.php/espace-consommateur-2/

You can also consult the website of the European Commission (EC) dedicated to consumer mediation: https://ec.europa.eu/info/live-work-travel-eu/consumers/resolve-your-consumer- complaint_en

 

 

Legal withdrawal in the context of a purchase made by a consumer on the siteWWW.UZS.FR

 

For the attention of the Seller:  the company "UZS"

Queyrol ZAC

Road to Aigaliers

30700 Napkins And Labaume

 

E-mail: eleveur@uzs.fr - Website: www.uzs.fR

Je soussigné,           _cc781905- 5cde-3194-bb3b-136bad5cf58d_         _cc781905-5cde-3194-bb3b -136bad5cf58d_           _cc781905-5cde -3194-bb3b-136bad5cf58d_       hereby notifies you of the following contract sale:915cc -5cde-3194-bb3b-136bad5cf58d_   _cc781905-5cde-3194-bb3b-136bad5cf5 8d_           _cc781905-5cde- 3194-bb3b-136bad5cf58d_           below :

Commandé le           _cc781905-5cde -3194-bb3b-136bad5cf58d_         _cc781905-5cde-3194-bb3b- 136bad5cf58d_      /reçu le     _cc781905- 5cde-3194-bb3b-136bad5cf58d_         _cc781905-5cde-3194-bb3b _cc78 1905-5cde-3194-bb3b-136bad5cf58d_        :

Consumer name:

Address of the  consumer:

Order number :

Signature of the consumer (only in case of notification of this form on paper):

Date :

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