Customer Complaint Form
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(Client's first and last name)
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(Customer's mailing address)
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(phone number)
Augustus Holdings
Asnyka 14/1, 05-800 Pruszkow, PL
COMPLAINT
I declare that I am submitting a complaint regarding the sale agreement concluded on .................................. and regarding the purchase of the following goods:
1) ………………………………………………………………… for the price of ……………………………………,
2) ………………………………………………………………… for the price of ……………………………………,
3) ………………………………………………………………… for the price of ……………………………………
Because the goods indicated above are defective because ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………….……………………
I attach / do not attach to this complaint * photographs showing the above-mentioned defectiveness of the goods. The above-described non-compliance of the goods with the contract is significant / insignificant *. In connection with the above, if the complaint is accepted, I request **:
1) presenting by the Seller a proposal to remove the defect, or
2) I request the goods to be replaced with a new one, or
3) instead of replacing the item, I request the removal of the defect, unless it is impossible to bring the goods into compliance with the contract in the manner chosen or it would require excessive costs compared to the method proposed by the Seller. I acknowledge that when assessing the excess of costs, the value of the goods without defects, the type and significance of the defect found are taken into account, and the inconvenience to which I would otherwise be satisfied
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I am aware that the personal data provided by me will be processed by the Seller for purposes related to the execution of this complaint and the fulfillment of related requests, and on the terms set out in the relevant legal provisions. I know that I have the right to request the data controller to access my data, rectify it, delete or limit processing, or object to processing, as well as the right to lodge a complaint with the supervisory authority.
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(name, surname and signature of the Client)
Additional information from the Seller: The personal data provided by you will be processed by the Seller for purposes related to the execution of your complaint and the fulfillment of related requests, and on the terms set out in the relevant legal provisions. You have the right to request the data controller to access your data, rectify it, delete or limit processing, or object to processing, as well as the right to lodge a complaint with the supervisory authority. More information is contained in the document "Information from the personal data administrator".
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* delete as appropriate.
** a choice should be made and the rest should be deleted.