Return Form
To :
black palms
Ebert & Sammer GbR
Bgm.-Deffner-Straße 4
D-85586 Poing
GERMANY
E-Mail shop@black-palms-shop.com.
I want to refund the concluded contract for the purchase of the following products
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Ordered on /received on
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Ordernumber
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Customer Name
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Customer Address
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Paid with PayPal: PayPal Mail address
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Paid with Bank transfer
Account owner___________________________________________
IBAN:_________________________________________________
SWIFT BIC:_____________________________________________
Customer signature
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Date
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