Complaint Form

for the www.pow.sk e-shop

Correspondence address: Mário Harman – www.pow.sk, Záhradnícka 698/38, 920 41

Leopoldov, Slovak Republic

Customer

Name and surname:

Address:

Phone No.:/email address:

Goods/service that is the subject of the complaint

No. of the purchase receipt or letter of warranty:

Name:

Date of purchase:

Accessories:

Description of defect:

______________________________________________________________________________

I would like to have my complaint handled in the following manner (tick your preferred option):

□ Goods exchange □ Goods repair □ Money return □ Purchase price discount

□ Other..............................................................

If the complaint is resolved through the return of the purchase price and you wish to have the money

returned to your bank account, please provide the IBAN number:

In(place): .................................... on(date): …………………

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

Customer signature