Loading...
Loading...
LC WAIKIKI ONLINE STORE
GENERAL TERMS AND CONDITIONS
ABOUT THESE TERMS AND CONDITIONS (“Terms and Conditions”)
The following pages provide detailed information about who LC WAIKIKI (“LC WAIKIKI”, “We”, “Us”) is and the legal terms and conditions that govern your use of www.lcw.com (“Website”, “Online Store”) as well as any purchase of a product you order online from LC WAIKIKI.
When registering an Account on our Website you shall be provided on your e-mail address with an electronic document containing the Terms and Conditions in force at the moment of registration. We recommend that you print and keep a copy of the Terms and Conditions for your future reference.
Before placing any orders on www.lcw.com, please read carefully the present Terms and Conditions. Please be aware that from time to time, these Terms and Conditions might be subject to updates without prior notice. Important amendments to the Terms and Conditions shall be notified to you on your registered e-mail address. An updated version of the Terms and Conditions shall always be available on the Website.
The version of the Terms and Conditions that will apply to your order will be the one available on www.lcw.com at the time you place your order, unless changes to these Terms and Conditions are required to be made by law or governmental authority and we might be required to apply such changes to orders previously placed by you.
By accessing and using the Website and as well as by placing orders on www.lcw.com, you confirm that you have read and understood the Terms and Conditions and that you agree to be fully bound by their provisions.
DEFINITIONS
Throughout the present Terms and Conditions we shall use certain recurring terms which shall bear the meaning indicated in the table below:
|
Products |
Clothing, footwear, accessories and all other fashion articles described on our Website. |
|
User |
Any person who accesses the Website. |
|
Registered User |
Any natural person aged 18 years old or older who registers an Account on the Website with the future purpose of placing Orders. |
|
Guest |
Any natural person aged 18 years old or older who visits the Website with the future purpose of placing Orders. |
|
Customer |
Any natural person aged 18 years old or older who places an Order on the Website and, subject to the acceptance of such order by LC WAIKIKI, becomes part of the distance sales agreement having as object the sale and purchase of LC WAIKIKI products. |
|
Order |
Material manifestation of the will to purchase LC WAIKIKI products under the present Terms and Conditions by using the electronic means available on the Website. |
|
Account |
Private Section of the Website that has attached an e-mail address and password and is used by the Registered User for ordering purposes. It contains various information about the Registered User and its activity on the Website, either submitted by the Registered User itself (personal data), either automatically registered by the Website (Order history, invoices etc.) |
|
Newsletter |
Commercial and advertising communication transmitted in exclusively in electronic format and on a current basis to the Registered User, subject to the Registered User consent in this sense, without representing an offer from LC WAIKIKI |
|
Content |
Any graphics, drawings, prints, photographs, images, sounds, music, video, audio, text, logos, button symbols, database, design, software and any other elements which can be visualized or accessed on the Website. |
For ease of reference, we have structured these Terms and Conditions into the following sections and subsections:
This Website is owned and operated by LC WAIKIKI RETAIL RO SRL, a company registered and functioning under the Romanian law, with headquarters in Romania, Bucharest, 6th District, 26Z Timisoara Blvd., Office 3B-2, 3rd Floor, duly registered with the Trade Registry Office attached to the Bucharest Tribunal under no. J40/9674/2009, having fiscal registration and VAT no. RO 26054330, part of the international LC WAIKIKI group of companies.
We are true to our philosophy that “Everyone Deserves to Dress Well” and therefore we enable you to enjoy the accessible fashion of the LC WAIKIKI brand through quality products at affordable prices.
Please feel free to address any queries to our Customer Service at the following contact details:
Correspondence address: Bdul Timisoara nr 26Z,etaj 3,bir 3B-2 Bucuresti sector 6 Romania
Phone: 444 4 529
E-mail address: romania@lcwaikiki.info
SECTION B. WEBSITE TERMS OF USE
The present Website Terms of Use (“Website Terms”) apply to your access and any use whatsoever of the LC WAIKIKI Website, as well as to any order you place on the Website, regardless of how you access the Website, or what technologies or devices you are using for such access.
By accessing, browsing, registering with, or using the Website in any manner available, as well as by placing an order on the Website, you confirm that you have read and understood Website Terms and that you agree to be bound by their provisions.
These Website Terms shall not limit or exclude any liability that we are not permitted to limit or exclude under applicable laws.
The Website is made available free of charge, to anybody who has access to internet connection.
We do not guarantee that our site, or any content on it, will always be available or be uninterrupted. We may suspend, withdraw, discontinue or change all or any part of our site without notice. We will not be liable to you if for any reason our site is unavailable at any time or for any period.
All electronic materials and elements which form the Content of this Website are protected by copyright, trade mark registrations and other intellectual and industrial property rights. All such rights are owned by or licensed to LC WAIKIKI RETAIL RO SRL, orto any of the companies in the LC WAIKIKI Group, its affiliates or to the suppliers of such content. All such rights are reserved to us.
You may only use this Website for domestic, private and lawful purposes.
You may not use the Website or any Content on it:
- in a way that breaches any applicable national or international laws or regulations,
- it in a way that infringes, restricts or inhibits anyone else''s rights to use and enjoy of this Website,
- for any commercial purposes whatsoever,
- to knowingly transmit, send or upload any data or material that contains viruses, Trojan horses, worms, spyware, adware or any other harmful programs or codes designed to adversely affect the operation of any computer software or hardware.
- to transmit, or procure the sending of, any unsolicited or unauthorized advertising or promotional material or any other form of similar solicitation (spam).
You also agree:
- not to copy, reproduce, frame, republish, download, print, post, re-post, broadcast, record, transmit, communicate to the public, link to, deep-link into, or distribute in any way the web pages or materials on the website or the computer codes or elements comprising the Website other than solely for your own personal use, without our prior written consent,
- not to alter or distribute in any way alterations of the Content of the Website, including but not limited to the removal of LC WAIKIKI logos and trademarks,
- not to damage, disrupt or impact the security of any part of this Website, its Content or any related network or software,
- not to make any fraudulent Order on the Website.
We reserve the right to immediately ban access to the Website to any User and close the Account of any Registered User who violates these provisions.
We shall use our reasonable endeavors in order to provide Content that is accurate, complete and up-to-date. The inclusion of any Products on the Website at a particular time does not imply or warrant that these products will be available at any time. We reserve the right to discontinue any Product at any time.
To the extent permitted by applicable laws, LC WAIKIKI disclaims all representations and warranties, express or implied in relation to the Content’s accuracy.
Should errors appear in relation to Product description and/or prices or should relevant data be missing from such Product information provided on the Website, LC WAIKIKI reserves the right to correct these errors and eventually, to cancel or make changes in specific orders to the extent of compliance with the applicable laws.
LC Waikiki aims to reflect the exact color of Products in the pictures displayed on Website. However, the Company assumes no responsibility for the color differences that may arise due to screen adjustments and use of different type of screens.
B.5. Damage to Your Computer or Other Device
LC WAIKIKI uses reasonable efforts to ensure that this Website is free from viruses and other malicious or harmful content. However, we recommend you to take all precautionary measures in order to ensure safe access to the Website and its Contest as we cannot guarantee that your use of this Website will not cause damage to your computer or other device. Except where required by applicable laws, LC WAIKIKI shall not be held liable to any person for any loss or damage they suffer as a result of viruses or other malicious or harmful content that they access from or via the Website.
The Website may include links to other sites which are not under the control of LC WAIKIKI. Such links are provided only for user convenience or information sharing purposes and they should not be interpreted as endorsement by us of those linked websites.
We assume no responsibility for the content of websites linked on our site. We will not be liable for any loss or damage that may arise from your use of them.
You may link exclusively to our home page, without our prior approval, provided that you:
- do so in a way that is fair and legal, on a website owned by you,
- do not damage LC WAIKIKI reputation or take advantage of it,
- do not suggest any form of association, approval or endorsement on our part where none exists,
- check for compliance of the website in which you are linking with the standards set forth in these Terms of Use.
We reserve the right to withdraw linking permission without notice.
These Website Terms also govern any Submissions you make on any LC WAIKIKI related third party website or pages such as our Facebook page, Twitter, Pinterest, YouTube or social networking site. All comments, images, videos and any other type of material posted on any third party social networking site must comply with these Website Terms and the third party social networking sites’ Terms of Use, as applicable.
SECTION C. SALE TERMS AND CONDITIONS
These sale terms and conditions of ("Sale Terms and Conditions") apply to any Order you place through www.lcw.com , regardless of how you access the Website.
Before placing an Order, you must read these Sale Terms and Conditions carefully. By placing an Order through the Website, you confirm that you have read, understood and agree to be bound by these Sale Terms and Conditions in their entirety. If you do not agree to these Terms and Conditions of Sale in their entirety, you must not order any Product through the Website.
C.1. Parties to the Distance Sale Agreement
These Sale Terms and Conditions regulate the distance sale agreement between the company LC WAIKIKI RETAIL RO SRL (the "Seller") and the customer (the "Customer") formalized through the Website for purchasing LC WAKIKI products via the Website.
In order to place an order through the Website, the Customer must be 18 years or older and be the final consumer. Minors are expressly excluded.
C.2. Registering an Account/Guest
In order place an Order, you can open an Account with us, or alternatively, you can choose to place your order as Guest, without registering an Account. However, you can choose to register an Account with us after submitting your Order as Guest.
When you register you are required to provide several personal details about yourself. Please make sure that all such personal data provided is true, accurate, current, and complete in all respects. You can update or correct your details at any time by accessing your Account. Please refer to our Privacy and Data Protection Policy for more information on how your personal information will be used and stored.
When you order through the Website as Guest you will still need to provide us with certain compulsory personal details which we collect for Order processing and billing purposes. We will not store the details that you provide via guest checkout (save for processing your order, or if you have opted in to receive our newsletter). For detailed information on how your personal information will be used and stored, please see our Privacy and Data Protection Policy.
When you register an Account you shall be asked you to provide a password in order to maintain your Account security. The account password you provide should be unique and kept secure. You are also responsible for maintaining the confidentiality of your password and any activities that occur under your Account. LC WAIKIKI shall not be liable to any person for any loss or damage which may arise as a result of any failure by you to protect your password or Account.
We may transfer your personal account information to servers located outside the country in which you live so that you can use your account in all LC Waikiki websites.
Should you become aware of or suspect any breach of security or any unauthorized use of your password or account, please notify LC WAIKIKI immediately.
C.4. Orders and Placing an Order
All Orders are subject to acceptance and availability, and items in your virtual shopping bag are not reserved and may be purchased by other customers.
Our display of Products on the Website represents an invitation and not an offer to sell those Products to you. An offer is made when you place the Order for the Products added in the virtual shopping bag. However, the distance sales agreement shall not be concluded until we accept your offer (see subsection C.5. below).
Placing an order through the Website requires the completion of the following steps:
ü Choose the Products that you like, select the color and size and add them to the virtual shopping bag,
ü Check your virtual shopping bag and proceed to complete order,
ü Enter the delivery and billing information and choose the method of payment,
ü Review all information submitted and confirm the Order. By confirming the Order, you fully and without reservation accept the version of the Terms and Conditions available of the Website which shall apply to the future distance sales agreement.
ü Have you chosen payment by card, you shall be requested to make the payment. If the payment is authorized, you will receive an automated acknowledgement e-mail for the receipt of the Order on the e-mail address you have provided. This acknowledgement does not represent an order confirmation or acceptance from LC WAIKIKI.
ü Have you chosen payment by any other method, you will receive an automated acknowledgement e-mail for the receipt of the Order on the e-mail address you have provided. This acknowledgement does not represent an order confirmation or acceptance from LC WAIKIKI.
Products are subject to availability. If we are unable to supply the products, we will inform you of this as soon as possible and your Order will not be accepted. If you have already paid for the Products, refund will be executed based on the method of payment in the order. When your process is completed, you will be informed via email.
All Orders that you place on this Website will be subject to our acceptance in accordance with section C.5. below.
C.5. Order Acceptance and Conclusion of the Distance Sale Agreement
Unless we have notified you that we do not accept your Order or you have cancelled it, Order acceptance and the conclusion of the distance sale agreement between you and LC WAIKIKI will take place at the point you receive an e-mail confirmation of your respective order.
Prior to dispatch of the Products, LC WAIKIKI has the right to decline any Order for any reason, including legal and regulatory reasons.
The email confirming that LC WAIKIKI has accepted your Order when your Order has been processed and is ready to be dispatched shall contain a reiteration of the ordered Products, agreement Price, chosen payment and delivery method.
The distance sale agreement is concluded for a determinate duration. Such agreement shall be deemed as terminated when both LC WAIKIKI and you will have executed the mutual obligations in the terms and requirements undertaken as per these Sale Terms and Conditions.
C.6. Payment Methods and Billing
LC WAIKIKI accepts the following payment methods:
- Credit card or debit card
By completing your card details while placing your Order you confirm that the credit or debit card being used is yours. All fields indicated as compulsory must be completed.
The applicable amount will immediately be debited on your card. LC WAIKIKI reserves the right to check the validity of the credit or debit card, its credit status in relation to the Order value and whether the address data of the Customer is correct. We may refuse Orders depending on the result of these checks.
In all cases where payment is made online, if bank fees and charges of any type (transfer, exchange) apply, they shall be incurred by you. For information on banking fees and charges please make prior reference to the bank which has issued your payment instrument.
- PayPal
When paying by PayPal, LC WAIKIKI reserves the right to check the validity of the PayPal account, that there are enough funds to cover the purchase sum and validate the billing address details of the purchaser. The applicable amount will immediately be debited on your PayPal account. LC WAIKIKI reserves the right to deny any purchase.
Please, make sure to also take into consideration your PayPal Services User Agreement.
- Cash on Delivery
The payment shall be made in cash to the courier delivering the parcel containing the ordered Products.
- Bank Transfer
Bank transfer payment, also known as a wire transfer, is a way of moving payment of your order amount to LC Waikiki.
Based on the personal details provided by you when you place an Order, LC WAIKIKI shall provide you with the corresponding hard copy invoice at the delivery moment of the Products.. By placing an Order you consent to such billing modality.
C.7. Delivery, Receipt and Transfer of Risks and Ownership
Delivery shall be performed by courier.
Please note that delivery charges and timescales vary depending on the type of Products ordered and the delivery address. You’ll find full details of our delivery charges and estimate timescale in the table below, with the mention that you may receive free delivery as promotional offer, given that certain requirement are met:
|
Country |
Shipping Fee |
Minimum order for free shipping |
Delivery time |
|
Romania |
16.90 RON | 160.00 RON | 1-2 working days |
|
Bulgaria |
6.90 BGN | 65.00 BGN | 2-3 working days |
|
Germany |
4.95 EUR | 75.00 EUR | 3-5 working days |
|
France |
3.95 EUR | 50.00 EUR | 4-6 working days |
|
Italy |
4.95 EUR | 60.00 EUR | 4-6 working days |
Orders are usually delivered within 7 (seven) to 14 (fourteen) business days from the date of Order acceptance. The delivery schedule is usually met, although LC WAIKIKI cannot guarantee punctuality. In any event, LC WAIKIKI shall use all reasonable endeavors to ensure delivery of the Products to you within 30 (thirty) days as of the acceptance date. You can track the status of the delivery either by accessing your Account, either by using the courier tracking services.
You must verify the state of the packaging upon delivery. If the package is damaged, you must not accept the delivery.
All risk in the Products you order (including risk of loss and/or damage to the products) shall pass to you when you or a third party indicated by you shall gain physical possession of the Product at the moment of delivery. Ownership of the Products shall not pass to you until we have received full payment.
We shall be under no liability for any delay or failure to deliver products if the delay or failure is wholly or partly caused by circumstances beyond our control.
C.8. Returns of Non-conforming Products
You have the right to return defective products or non-conforming products. You have 2 (two) months from the moment of detecting product non-conformity to inform in writing LC WAIKIKI about the defect or lack of conformity and to initiate the return the product to LC WAIKIKI. Such defect or lack of conformity has to become apparent during a 2 years (two) term starting with the delivery date. For products which have an average duration of use lower than 2 (two) years, the 2 (two) years term shall be reduce to the average duration. For further reference, please observe the Warranty certificate you received together with the Products.
Should your claims be justified, LC WAIKIKI shall refund the value of the Product, as well as the direct costs involved in the return, within 15 (fifteen) calendar days starting with the date on which you have informed us about the lack of conformity or with the date you have handed-over to us or to a delegated person the product based on a transfer minutes.
You have the right to cancel all or part of your Order within 14 (fourteen) calendar days starting with the day on which you (or someone you nominate, other than a carrier) receive the Products (or the last Product in case of fragment delivery), without giving any reason.
For exercising your right of withdrawal, you can either:
Pack the items securely, in the original packaging if possible, and enclose the return form which is on the back of your invoice.
In your parcel you will see a label with the return address and barcode, which you should attach to your parcel.
If you cannot find it in your parcel, send it to the following address:
Bd. Timisoara nr 26Z, etaj 3, birou 3B-2, sector 6 061341, Bucuresti, ROMANIA
To meet the withdrawal deadline, it is sufficient for you to send your communication concerning your exercise of the right of withdrawal before the withdrawal period has expired.
Effects of withdrawal
If you chose to withdraw we shall reimburse to you all payments received from you, including the costs of delivery (with the exception of the supplementary costs resulting from your choice of a type of delivery other than the least expensive type of standard delivery offered by us), without undue delay and in any event not later than 14 (fourteen) days from the day on which we are informed about your decision to withdraw from this contract. We will carry out such reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise. We may withhold reimbursement until we have received the goods back or you have supplied evidence of having sent back the goods, whichever is the earliest.
The following Products are exempt from withdrawal: made to measure orders or personalized Products, lingerie and swimwear Products which are sealed due to hygiene reasons.
Your obligations in case of withdrawal:
- to return the Products or hand them over to us or to a person authorized by the trader to receive the goods, without undue delay and in any event not later than 14 (fourteen) days from the day on which you have communicated us your decision to withdraw,
- to return the Products in good conditions and in their original packaging,
- as applicable, you shall only be liable for any diminished value of the goods resulting from the handling of the goods other than what is necessary to establish the nature, characteristics and functioning of the goods.
LC WAIKIKI’s obligations in case of withdrawal:
- to reimburse all payments received from you, including, if applicable, the costs of delivery without undue delay and in any event not later than 14 (fourteen) days from the day on which we have been informed of your decision to withdraw,
- In the event that we have sent goods to you and you have cancelled your order, we may withhold reimbursement until we have received the goods back or you have supplied evidence of having sent the goods back, whichever is the earliest.
C.10. Product Descriptions and Prices
A description of the main characteristics of Products can be found on the Product pages of the Website. We have taken reasonable precautions to try to ensure that all Products have been fairly described, however please note that whilst we try to display the colours of our Products accurately on the Website, the actual colours you see will depend on your monitor settings and we cannot guarantee that your monitor''s display of any colour will accurately reflect the colour of the product on delivery.
Prices for Products on the Website appear on the Product pages and include VAT. Delivery taxes and banking taxes, as applicable, can be added to the final Price. Therefore the final Price incurred by you shall be composed of the following elements: Product Price + Delivery taxes (if applicable) + banking taxes (if applicable).
Prices and Offers may vary and may only be available for limited periods. All Prices and Offers are subject to availability and may be withdrawn or amended at the discretion of LC WAIKIKI. The Prices on the Website may differ to prices in retail stores, catalogues or elsewhere. Internet offers relate to internet transactions only and may not be available in store. Likewise, temporary or local special offers in store do not apply to internet prices unless expressly specified.
We have taken reasonable precautions to try to ensure that all Products are correctly priced. However, it is possible that, despite best efforts, some of the Products listed on the Website may be incorrectly priced. Prices shown in error shall not be binding on LC WAIKIKI.
If LC WAIKIKI discovers an error in the price of the Products you have ordered, we will inform you as soon as possible. LC WAIKIKI will give you the option of reconfirming your Order at the correct price or cancelling it.
For Products sold on our Website we guarantee conformity and quality, as per the related description on our Website and as per the provided Warranty Certificate.
All our Products bear:
- a commercial guarantee of 14 (fourteen) – 30 (thirty)days, representing an commitment made by LC WAIKIKI to you, to refund the Price, repair or replace the Product, without further additional taxes in you charge, in case the Product does not correspond to the conditions indicated within the Warranty Certificate or related publicity,
- a legal conformity guarantee of maximum 2 (two) years as customer protection for lack of conformity granted by law, representing the legal obligation of LC WAIKIKI to bring the product to conformity by repair or replacement or to reimburse the Price, without further additional taxes in you charge. For products which have an average duration of use lower than 2 (two) years, the 2 (two) years term shall be reduce to the average duration.
LC WAIKIKI is only responsible for losses that are foreseeable consequence of our breach of these Terms and Conditions. We will not be liable to you if we are prevented or delayed from complying with our obligations under these Sale Terms and Conditions by anything you (or anyone acting on your behalf) do or fail to do or due to events which are beyond our reasonable control.
You must follow any instructions/advice we give you to keep Products you ordered safe (including any instructions or product manuals provided with the products). We cannot accept liability for damage to Products which is caused by your failure to follow such instructions/advice.
Nothing in these Sale Terms and Conditions shall limit or exclude LC WAIKIKI’s liability for (i) death or personal injury caused by our negligence, (ii) fraud, (iii) any breach of the obligations implied by applicable compulsory laws or (iv) any liability which cannot be excluded by law.
Communications, including notices, requests, complaints, between you and LC WAIKIKI will be primarily electronic through e-mail or notifications posted on the Website. By accessing the Website and placing Orders you agree to this electronic means of communication and you acknowledge that all agreement, notices, information and other communications that LC WAIKIKI provides to you electronically comply with any legal requirement that such communications be in writing and on durable medium.
SECTION E. COMPLAINT SETTLEMENT PROCEDURE
If you have a complaint about us email romania@lcwaikiki.info giving full details including date of purchase and order reference number where applicable and your full name and address and contact details.
We shall provide you with our official reply/solution, by e-mail, within 5 (five) business days as of the receipt of your complaint.
Should you be unsatisfied with our proposal, you can further address your complaints:
- to the National Authority for Consumer Protection - Regional Commissioner for Consumer Protection Bucharest - Ilfov region
or
- on the Online Dispute Resolution platform (ODR platform developed by the European Commission under REGULATION (EU) No 524/2013 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 21 May 2013 on online dispute resolution for consumer disputes and amending Regulation (EC) No 2006/2004 and Directive 2009/22/EC) at http://ec.europa.eu/odr.
SECTION E. GOVERNING LAW AND JURISDICTION
These Terms and Conditions are governed by and construed in accordance with Romanian law. However, in accordance with article 6(2) of the Rome I Regulation (Regulation (EC) No 593/2008 of the European Parliament and of the Council of 17 June 2008 on the law applicable to contractual obligations), you, as consumer, also enjoy the protection granted to you by your national laws which cannot be derogated from by agreement.
Any dispute or discrepancy arising from the application or interpretation of these Terms and Conditions, including the Sale Terms and Conditions, which cannot be amiably settled, shall be settled by the Romanian courts from Bucharest. However, should this choice of jurisdiction be discouraging to you due to a considerable distance from your location, this clause may be renegotiated.
You may not assign or sub-contract any of your rights or obligations under these Terms and Conditions to any third party unless we agree in writing.
We may assign, transfer or sub-contract any of our rights or obligations under these Terms and Conditions to any third party at our discretion, provided that such third party shall ensure the same level of guarantee and liability towards you.
No relaxation or delay by us in exercising any right or remedy under these Terms and Conditions shall operate as waiver of that right or remedy or shall affect our ability to subsequently exercise that right or remedy. Any waiver must be agreed by us in writing.
If any of these Terms and Conditions are found to be illegal, invalid or unenforceable by any court of competent jurisdiction, the rest of these Terms and Conditions shall remain in full force and effect.
SECTION G. YOUR THOUGHTS
We are always open to your valuable opinions and feedback regarding our Website and you may always contact us with your comments and suggestions through our contact information specified under A.2.
ANNEX NO. 1.
To the Sale Terms and Conditions
WITHDRAWAL FORM ++
(complete and return this form only if you wish to withdraw from the distance sales agreement)
To LC WAIKIKI RETAIL RO SRL, a company registered and functioning under the Romanian law, with headquarters in Romania, Bucharest, 6th District, 26Z Timisoara Blvd., Office 3B-2, 3rd Floor, duly registered with the Trade Registry Office attached to the Bucharest Tribunal under no. J40/9674/2009, having fiscal registration and VAT no. RO 26054330, romania@lcwaikiki.info
I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) distance sales agreement of the following Products (*)
Ordered on (*)/received on (*),
Name of consumer(s),
Address of consumer(s),
Signature of consumer(s) (only if this form is notified on paper),
Date