Name of dealer: Tomán Lifestyle Kft.

Address of the dealer: H-1126 Budapest, Szendrő utca 57/B.

E-mail address of the dealer: lipbar@bytoman.hu

Date of order:

Order number:

Name of the consumer:

Address of the consumer:

E-mail address of the consumer:

Name of the product concerned by the complaint

Description of the complaint about the product ordered:

Dated:

Consumer’s signature