Form for Withdrawal from the Purchase Agreement

Recipient (Seller):

Gaia Store
Na Farském 31, Ostrava 72000

Date of announcement: 2026

Order number *

Invoice number

Order date *

Delivery date *

Full name *

Street and house number *

City *

ZIP code *

Email address *

Phone number

Product Specifications *

Reason for withdrawal

Bank Account for Refunds *

By submitting this form, I am notifying the seller of my withdrawal from the purchase agreement within the time limit specified by law.