Terms & Conditions of Sale

Last updated: 15 August 2026

These Terms and Conditions of Sale govern the distance purchase of products offered through the website http://www.levantesi.store (hereinafter, the “Website”).

The seller is Levantesi S.r.l., with registered office at Via Santa Caterina no. 1850, 63811 Sant’Elpidio a Mare (FM), Italy, VAT No. 00877290445, registered with the competent Italian Companies Register.

E-mail: info@levantesi.store
Telephone: +39 338 7531794

1. Scope of application

These Terms and Conditions apply to purchases made through the Website by customers acting as consumers, namely for purposes unrelated to their business, commercial, craft or professional activities.

Online orders may be placed by customers residing or domiciled in countries for which the Website checkout makes a shipping method available.

For destinations that are not enabled at checkout, you may contact Levantesi S.r.l. at info@levantesi.store to check whether an order can be placed, the applicable shipping costs and the relevant conditions.

Purchases made by companies, professionals, associations, corporations or other persons acting in the course of their professional or business activities (B2B), including customers purchasing with a VAT number, are currently handled directly by the Levantesi team and may be subject to specific conditions communicated at the quotation or ordering stage.

Before submitting an order, the Customer is invited to read these Terms and Conditions carefully. They are made available on the Website in a manner that allows them to be consulted and stored.

2. Products and their nature

Levantesi S.r.l. sells products and accessories mainly intended for men’s and women’s artistic gymnastics, including gymnastics shoes, half shoes, gymnastics grips, wrist supports, wristbands, straps, athletic tape, training accessories and other products shown on the Website.

The main characteristics of each product are described on the relevant product page. Before purchasing, the Customer is invited to carefully review the descriptions, images, materials, instructions for use, care instructions, size guides and any other information made available.

Product images are for illustrative purposes. Any differences in colour display caused by the screen or device used do not in themselves constitute a lack of conformity.

Certain products sold by Levantesi S.r.l., and in particular gymnastics grips, are sports products which, by their nature, are exposed during use to significant stress, pulling forces, pressure, friction and progressive deformation.

The actual useful life of these products may vary considerably depending on factors including the frequency and intensity of training, the athlete’s technical and competitive level, the force applied, the apparatus used, the use of gymnastics chalk, environmental conditions and the methods of care and storage.

In particular, when used competitively or at high intensity, gymnastics grips may show a significant level of wear even within a few months. The duration of the legal guarantee of conformity therefore does not constitute a guarantee that the product will physically last or remain usable for the same period.

Normal wear and tear, consumption and changes to the product resulting from its use do not in themselves constitute a lack of conformity.

3. Proper use of products

Products must be used exclusively for their intended purpose and in accordance with any instructions provided, ordinary rules of use and care, and the information provided on the Website.

To the extent permitted by law, Levantesi S.r.l. shall not be liable for damage resulting from improper use of a product, use incompatible with its intended purpose, unauthorised alterations or modifications, improper maintenance, or use on damaged, excessively abrasive or otherwise unsuitable equipment.

Any liability that cannot be excluded under applicable law remains unaffected.

4. How to place an order

To purchase a product, the Customer may select it through the relevant category or product page, choose any available variations and quantities, and add it to the shopping cart.

Before completing the purchase, the Customer may review and modify the contents of the cart. During checkout, the Customer will be asked to provide the information required for order management, invoicing where applicable, shipping and payment.

The Customer is responsible for ensuring that the information provided is accurate and complete, particularly the delivery address, email address and telephone number.

Before the order is submitted, the Customer is shown a summary of the products, price, any applicable taxes, shipping costs and the total amount payable to Levantesi S.r.l

By submitting the order through the relevant confirmation button and accepting these Terms and Conditions, the Customer submits a purchase request.

The Customer will receive a confirmation at the email address provided during checkout containing the main information relating to the order.

If, after receipt of the order, a product is exceptionally unavailable or another circumstance prevents its supply, Levantesi S.r.l. will promptly inform the Customer and, where necessary, refund any amounts already paid for unavailable products.

Certain products, including made-to-measure items or special products, may not be available for direct purchase through checkout. In such cases, the Customer may request a quotation using the contact details or forms provided on the Website.

5. Prices, currency and taxes

All prices displayed on the Website are expressed in Euro (€), unless otherwise indicated.

For sales subject to VAT within the European Union, prices displayed to consumers include the applicable VAT in accordance with current legislation.

Shipping costs not included in the product price are shown separately during checkout before the order is confirmed.

For sales to non-EU countries, the tax treatment of the transaction is determined in accordance with applicable legislation.

Any customs duties, import taxes, import VAT/GST, customs clearance fees, brokerage charges or other charges imposed in the country of destination are not included in the amount paid to Levantesi S.r.l., unless expressly stated otherwise during checkout.

The contractual price payable to Levantesi S.r.l. is the amount shown in the final order summary when the purchase is confirmed.

In the exceptional event of a manifest and recognisable error in a published price, Levantesi S.r.l. will inform the Customer before the order is fulfilled, allowing the Customer, where possible, either to confirm the purchase at the correct price or to cancel the order and receive a refund of any amounts already paid.

6. Payment methods

The Customer may make payment using the methods actually available during checkout.

Electronic payments may be processed through secure payment providers, including Stripe and WooPayments, depending on the method selected and its availability.

Depending on the device, country and payment service configuration, available methods may include credit or debit cards, Apple Pay, Google Pay and other payment methods displayed during checkout.

If advance bank transfer is available, the order will normally be prepared for shipment once the amount due has been credited to the relevant account. Payment must be made within 5 working days unless otherwise specified; if payment is not received within this period, the order may be cancelled.

Levantesi S.r.l. may temporarily suspend the processing of an order if payment is not authorised, reasonable suspicions of fraud arise or further verification of the transaction is required.

7. Shipping and delivery

The shipping options and corresponding costs available for the address provided by the Customer are displayed during checkout.

Levantesi S.r.l. may entrust delivery to different carriers and logistics services depending on the destination, parcel weight and dimensions, order value and operational requirements.

The commercial name of a shipping option displayed during checkout, such as “International Express”, may identify a service level or type and does not necessarily identify a specific carrier.

Where required for operational or logistical reasons, Levantesi S.r.l. may use a carrier other than the one initially envisaged, provided that a substantially equivalent service is used and this does not result in additional costs to the Customer that have not been agreed in advance.

Orders are normally processed as quickly as possible following confirmation of payment.

Delivery times indicated on the Website, in the FAQs, during checkout or in order-related communications are estimates, unless a specific delivery date has expressly been agreed as essential.

Periods of high order volume, public holidays, customs procedures, force majeure or other circumstances that cannot reasonably be controlled by Levantesi S.r.l. may affect estimated delivery times, without prejudice to the consumer’s rights under applicable law.

Unless otherwise stated for the selected service, delivery to upper floors is not included.

Where available, the Customer will receive the information required to track the shipment by email, through the order tracking page or by another method provided by the carrier.

8. Risk during transport and damaged parcels

Where shipping is arranged by Levantesi S.r.l. through a carrier appointed by the Company, the risk of loss of or damage to the goods during transport remains with Levantesi S.r.l. until delivery to the Customer or to a third party designated by the Customer, subject to the cases provided for under applicable law.

If the parcel shows visible damage, openings, crushing, tampering or other anomalies at the time of delivery, the Customer is advised, where possible, to accept the parcel subject to a specific written reservation describing the damage and to photograph the packaging and contents immediately.

The Customer is invited to report any issue as soon as possible to info@levantesi.store, stating the order number and, where useful, attaching photographs of the packaging and product.

The request to make a specific reservation and promptly report any damage is intended to facilitate checks and any claims against the carrier and does not limit any mandatory rights granted to consumers.

9. International shipping and non-EU destinations

Levantesi S.r.l. ships to the countries made available during checkout.

For destinations not enabled at checkout, you may contact us at info@levantesi.store to check whether shipping is available and to request a quotation.

Unless otherwise indicated during checkout, shipments to enabled non-EU destinations are made on a DAP (Delivered at Place) basis.

For DAP shipments, the amount paid on the Website includes the purchased products and the shipping cost shown during checkout, but does not include any:

customs duties;
VAT, GST or other import taxes;
customs clearance fees;
brokerage or handling charges applied by the carrier;
other charges imposed by the authorities in the country of destination.

Where applicable, these amounts are the responsibility of the recipient and may be requested by the carrier, customs authorities or other appointed parties before delivery.

The Customer is responsible for the accuracy of the information provided for shipping purposes and must cooperate, where necessary, with the carrier or customs authorities to enable customs clearance of the goods.

Customs procedures may result in additional delivery time beyond normal estimates.

If an automatic shipping rate is not available due to the weight, dimensions, order value or destination, the Customer may contact Levantesi S.r.l. to request a personalised quotation.

10. Cancellation of an order before shipment

The Customer may request cancellation of an order before it has been handed over to the carrier by contacting Levantesi S.r.l. as soon as possible.

If the order has not yet been shipped and cancellation is technically possible, Levantesi S.r.l. will cancel the order and refund any amount already paid.

Once the goods have been shipped, the simple order cancellation procedure no longer applies. Where applicable, consumers may nevertheless exercise their right of withdrawal in accordance with the conditions set out below.

Levantesi S.r.l. may cancel an order for justified reasons, including subsequent unavailability of the product, inability to complete delivery, failure to obtain payment authorisation, reasonable suspicions of fraud, a manifest pricing error or other circumstances that make performance of the contract impossible.

In such cases, the Customer will be informed and any amounts already paid for the cancelled order will be refunded.

11. Right of withdrawal

Subject to the exceptions provided for by law, the consumer has the right to withdraw from the contract within 14 days without having to provide any reason.

For contracts for the sale of goods, the withdrawal period begins on the day on which the consumer, or a third party designated by the consumer other than the carrier, acquires physical possession of the goods.

Where several goods are ordered in one order and delivered separately, the period begins on the day on which the consumer, or a third party designated by the consumer other than the carrier, acquires physical possession of the last item.

The consumer may communicate the decision to withdraw:

by sending an explicit statement to info@levantesi.store;
by using the model withdrawal form provided at the end of this page;
by using the online function

“Withdraw from the contract here”
.

The online function allows consumers to enter and review the information relating to their withdrawal declaration and to confirm its submission using the dedicated “Confirm withdrawal” function.

Following confirmation, Levantesi S.r.l. will send, without undue delay, to the email address indicated by the consumer an acknowledgement of receipt containing the declaration received, its reference number and the date and time of submission.

12. Return of products following withdrawal

The consumer must return the goods without undue delay and in any event within 14 days from the date on which the decision to withdraw was communicated.

Unless otherwise indicated by Levantesi S.r.l., products must be returned to:

Levantesi S.r.l.
Via Santa Caterina n. 1850
63811 Sant’Elpidio a Mare (FM)
Italia

The direct cost of returning the goods following exercise of the right of withdrawal is borne by the consumer unless otherwise stated or otherwise provided by law.

We recommend using a trackable shipping service and retaining proof of shipment until the procedure has been completed.

During the withdrawal period, the Customer must handle the product with due care and only to the extent necessary to establish its nature, characteristics, size, fit and functioning.

The consumer is responsible for any diminished value of the product resulting from handling or use beyond what is necessary for this purpose.

When assessing the condition of a returned product, Levantesi S.r.l. may take into account, by way of example, the presence of wear, abrasions, deformation, permanent creases, alteration of holes, gymnastics chalk, dirt, sweat, odours, damage, changes to the material or other signs of use.

If, as a result of use or alterations, the product can no longer be marketed as new, Levantesi S.r.l. may assess the objective reduction in the value of the goods for the purpose of determining the refundable amount, within the limits permitted by applicable law.

Where possible, the product should be returned together with its packaging and any accessories, labels and documentation received.

13. Size checking and use of gymnastics grips

Gymnastics grips are products which, by their nature, begin to adapt and change according to the athlete’s hand and the stresses applied during use.

Even a single use of gymnastics grips on an apparatus may alter their shape, curvature, leather tension, holes and other characteristics, making the product no longer suitable for resale as new.

For this reason, before using the grips on an apparatus, the Customer is strongly advised to check the size carefully by consulting the Size Charts, Size Guide and instructions available on the Website.

For the sole purpose of checking size and fit, the Customer may put the gymnastics grips on a clean, dry hand without applying gymnastics chalk and without subjecting them to the stresses associated with sporting use.

For size-checking purposes, the product must not be used during training, exercises or trials on an apparatus and must not be subjected to the athlete’s body weight, pulling forces, friction or other stresses associated with its intended sporting use.

Using gymnastics grips on the high bar, still rings, parallel bars or other apparatus constitutes actual use of the product and may cause, even from the first session, changes including adaptation and deformation of the leather, creasing, tensioning, abrasions, modification or enlargement of the holes and other irreversible changes.

The application of gymnastics chalk or the presence of sweat, dirt, residue or other signs resulting from training are additional indications that the product has actually been used.

If, when exercising the right of withdrawal, the returned product shows alterations resulting from handling or use beyond what was necessary to establish its nature, characteristics, size and functioning, the Customer is responsible for the resulting diminished value within the limits provided for by applicable law.

Where such alterations objectively prevent Levantesi S.r.l. from marketing the product again as new, this circumstance will be taken into account when assessing the diminished value of the goods.

14. Refunds following withdrawal

Where the right of withdrawal has been validly exercised, Levantesi S.r.l. will refund the amounts due within the time limits established by applicable law.

Where the consumer withdraws from the entire order, the refund will include, where due, the cost of the least expensive standard delivery method offered for that order.

Any additional costs resulting from the consumer’s voluntary choice of a more expensive delivery method than the least expensive standard delivery method offered will not be refunded, within the limits provided by law.

Unless Levantesi S.r.l. has offered to collect the goods itself, the refund may be withheld until the returned products are received or until the consumer provides evidence that they have been sent back, whichever occurs first.

Any diminished value attributable to handling or use beyond what is necessary to establish the nature, characteristics and functioning of the product may be deducted from the refundable amount in accordance with applicable law.

As a rule, the refund will be made using the same payment method used by the Customer for the original transaction, unless otherwise agreed and provided that the consumer does not incur any additional costs.

15. Exceptions to the right of withdrawal

The right of withdrawal is excluded in the cases provided for by applicable law.

In particular, the right of withdrawal does not apply to the supply of goods made to the consumer’s specifications, made to measure or clearly personalised.

If a product falls within one of the statutory exceptions, this will be indicated to the Customer before purchase where required.

16. Size exchanges and voluntary replacements

The commercial size exchange procedure offered by Levantesi S.r.l. is separate from the statutory right of withdrawal and the legal guarantee of conformity.

If the Customer has selected an unsuitable size, the Customer may contact Levantesi S.r.l. to check whether an exchange is possible, subject to availability of the requested product.

To use the commercial size exchange service, the product must be returned intact, unused, unworn, undamaged and in a condition that allows it to be marketed again as a new product.

For gymnastics grips, a size exchange will not be accepted if the product has been used during training, exercises or trials on gymnastics apparatus.

In particular, the product must not show gymnastics chalk, abrasions, deformation, creases resulting from use, enlargement or alteration of the holes, tensioning of the leather, dirt, sweat or other signs of use.

Because even a single use on an apparatus can permanently alter the shape and characteristics of gymnastics grips, we strongly recommend checking the size carefully before any use on an apparatus.

Unless otherwise indicated or included in a promotion, the cost of returning the product and the cost of shipping the replacement item are borne by the Customer.

These conditions relating to voluntary size exchanges do not limit the consumer’s statutory rights concerning withdrawal and the legal guarantee of conformity.

17. Size guide

The Website provides guides, charts, videos and other information relating to product sizing.

The Customer is invited to consult this information carefully before placing an order and, in case of doubt, may contact Levantesi S.r.l. for assistance in selecting the appropriate size.

The Customer remains responsible for the final choice of size based on the measurements provided or taken, without prejudice to any rights granted under applicable law.

18. Legal guarantee of conformity, product life and normal wear and tear

Consumers benefit from the legal guarantee of conformity provided for by the Italian Consumer Code.

For new goods, Levantesi S.r.l., as seller, is responsible for any lack of conformity existing at the time of delivery that becomes apparent within two years from delivery of the goods, in accordance with applicable law.

The two-year duration of the legal guarantee does not constitute a guarantee that the product will physically last for two years. The guarantee concerns original lack of conformity and does not cover normal consumption, wear or deterioration resulting from use of the product. The guarantee concerns original lack of conformity and does not cover normal consumption, wear or deterioration resulting from use of the product.

Certain Levantesi products, particularly gymnastics grips, are sports products exposed during normal use to significant mechanical stress, friction, pulling forces, pressure and progressive deformation.

Their actual useful life depends on factors including the frequency and intensity of training, the athlete’s technical and competitive level, the weight and force applied, the apparatus used, friction, the use of gymnastics chalk, perspiration, environmental conditions and methods of care and storage.

When used competitively or particularly intensively, a product may therefore show significant wear or reach the end of its useful life even within a few months, without this automatically constituting a lack of conformity.

The following do not, in themselves, constitute a lack of conformity covered by the legal guarantee:

normal wear and tear and progressive consumption resulting from use;
thinning, abrasion or deterioration of materials resulting from training;
deformation or adaptation of the leather resulting from use;
enlargement or alteration of the holes resulting from stresses applied during use;
changes caused by pulling forces, friction, pressure and other normal stresses associated with sporting activity;
damage caused by improper use or use other than the product’s intended purpose;
damage resulting from damaged, excessively abrasive or unsuitable equipment;
damage resulting from improper maintenance or storage;
damage resulting from excessive moisture, dirt, chemicals, unauthorised washing or other subsequent external conditions;
modifications or interventions made to the product by the Customer.

If a possible lack of conformity is identified, the Customer is invited to contact Levantesi S.r.l. as soon as the issue is noticed by writing to info@levantesi.store providing the order number, a description of the issue and, where useful, photographs of the product.

For products subject to significant wear, prompt notification makes it easier to assess whether the issue is attributable to an original lack of conformity or to normal deterioration resulting from use. This request for prompt notification does not constitute a time limit resulting in loss of the consumer’s mandatory statutory rights.

Where a lack of conformity covered by the legal guarantee exists, the consumer is entitled to the remedies provided for under applicable law.

For the purpose of bringing the goods into conformity, the consumer may choose between repair and replacement in the cases provided for by law, unless the chosen remedy is impossible or, compared with the alternative, would impose disproportionate costs on the seller.

Where, because of the nature of the product or defect, repair is not technically possible or reasonable, the remedy applicable under the relevant legislation will be applied.

Where provided for by law, a proportionate reduction in price or termination of the contract may also apply.

Nothing in these Terms limits or excludes any mandatory rights granted to consumers under applicable law.

19. Customer account

When creating an account on the Website, the Customer must provide accurate, complete and up-to-date information.

The Customer is responsible for keeping login credentials confidential and must promptly inform Levantesi S.r.l. if the Customer becomes aware of unauthorised access or a potential security issue relating to the account.

Levantesi S.r.l. may suspend or close an account in the event of breaches of these Terms, fraudulent or unlawful use, security issues or other legitimate reasons.

The Customer may request closure of the account by contacting Levantesi S.r.l., without prejudice to any obligation to retain certain information under tax, administrative, accounting or other applicable legislation.

20. Use of the Website

Users undertake to use the Website in accordance with applicable law and these Terms.

The Website may not be used for unlawful, fraudulent or unauthorised purposes. In particular, users must not:

impersonate Levantesi S.r.l., its employees, collaborators or other persons;
intentionally provide false information or use another person’s identity;
send spam or abusive communications through the Website’s services;
attempt to compromise the security or proper operation of the Website;
introduce viruses, malware, ransomware or other harmful code;
attempt to gain unauthorised access to systems, servers, databases or accounts;
carry out cyberattacks, including DoS or DDoS attacks;
use automated tools in a way that compromises the operation of the Website or infringes the rights of Levantesi S.r.l. or third parties;
use the Website in breach of applicable law.

21. Availability, errors and information updates

Levantesi S.r.l. takes reasonable measures to keep information concerning products, prices and availability accurate and up to date.

Despite these checks, material, technical or typographical errors may occasionally occur. Levantesi S.r.l. reserves the right to correct such errors and update the information available on the Website.

If an error affects an order that has already been submitted, the Customer will be informed promptly and the necessary measures will be taken in accordance with applicable law, including, where necessary, refunding amounts already paid.

22. LEVANTESI trademark and intellectual property

The LEVANTESI distinctive sign and trademark, including its figurative representation, is subject to protection and industrial property registration procedures.

On 21 January 2026, Levantesi S.r.l. filed in Italy trademark application no. 302026000009751for the LEVANTESI trademark in respect of goods falling within Nice Classification classes 25 and 28.

On the basis of that application, on 8 June 2026, international trademark application no. 3420260000097717 was also filed, linked to Italian application no. 302026000009751, in order to request extension of protection of the trademark to designated territories through the applicable international system.

The national and international filing procedures are handled with the professional assistance and representation indicated in the relevant filing documents; documents relating to the international application indicate an elected address for service at Praxi Intellectual Property S.p.A., based in Civitanova Marche (MC), Italy.

The filing of the applications and any subsequent international registration produce effects in individual territories according to the relevant procedures, decisions of the competent authorities, classes of goods and applicable laws.

Unless otherwise indicated, the contents of the Website, including by way of example texts, photographs, images, graphics, logos, trademarks, names, figurative elements, designs, videos, documentation and other materials, are owned by Levantesi S.r.l. or are used on the basis of rights, authorisations or licences granted by their respective owners.

Such content is protected by applicable copyright, trademark, distinctive sign and other intellectual and industrial property laws.

Except where permitted by law or authorised in writing, reproduction, copying, distribution, modification, publication, commercialisation, imitation, counterfeiting or unauthorised use of the trademark, logo, content or other distinctive signs of Levantesi S.r.l. is prohibited.

It is also prohibited to use names, signs, images or other elements capable of creating confusion as to the commercial origin of products or the existence of an affiliation, authorisation, distribution or collaboration relationship with Levantesi S.r.l. where no such relationship exists.

Levantesi S.r.l. reserves the right to protect its intellectual and industrial property rights using the remedies available under applicable law in the relevant territories.

Anyone who believes that content on the Website infringes their intellectual property rights may send a notice to info@levantesi.store, specifying the right allegedly infringed, the content concerned, its location on the Website and the information necessary to allow the report to be assessed.

23. Protection of personal data

The Customer’s personal data is processed by Levantesi S.r.l. in accordance with applicable data protection legislation.

For detailed information regarding the purposes and legal bases of processing, categories of personal data processed, recipients, retention periods, any international transfers and the rights of data subjects, please refer to the Privacy Policy and Cookie Policy available on the Website.

24. Order storage and communications

Orders and related information are retained electronically in the systems used by Levantesi S.r.l. for e-commerce and administrative management, in accordance with applicable security measures and retention periods.

The Customer receives the order confirmation and the main communications relating to the purchase by email.

If the Customer has an account, information made available in the personal account area may also be viewed there.

25. Complaints and alternative dispute resolution

For any issue relating to an order or product, the Customer is invited to contact Levantesi S.r.l. first at info@levantesi.store in order to attempt to reach a direct resolution.

Without prejudice to the right to bring proceedings before the competent courts, where provided for under applicable law consumers may use alternative dispute resolution (ADR) procedures before competent ADR bodies.

26. Applicable law

These Terms and Conditions and sales contracts concluded through the Website are governed by Italian law, without prejudice to any mandatory consumer protection provisions that may apply under relevant national, European Union or international law.

The choice of Italian law does not deprive consumers of any mandatory protection to which they may be entitled under applicable law.

Any dispute will be subject to the jurisdiction of the court determined in accordance with the applicable mandatory rules, including those protecting consumers.

27. Amendments to the Terms and Conditions

Levantesi S.r.l. may amend or update these Terms and Conditions to reflect legal, technical, organisational or commercial changes.

The version applicable to each order is the version made available to and accepted by the Customer at the time the relevant contract is concluded.

Subsequent amendments to these Terms and Conditions do not retroactively alter the terms applicable to orders already concluded, except where required by mandatory provisions of law.

The date of the latest update is indicated at the beginning of this page.

28. Contact details

For information, order-related requests, assistance, returns or guarantee claims, please contact:

Levantesi S.r.l.
Via Santa Caterina n. 1850
63811 Sant’Elpidio a Mare (FM)
Italia
E-mail: info@levantesi.store
Telephone: +39 338 7531794

29. Model withdrawal form

The following form may be used by consumers wishing to exercise their right of withdrawal. Use of this form is not mandatory.

To:
Levantesi S.r.l.
Via Santa Caterina n. 1850
63811 Sant’Elpidio a Mare (FM)
Italy
E-mail: info@levantesi.store

I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods:

____________________________________________

Order number: ______________________________

Order date: ____________________________

Date on which the goods were received: _________________

Name of consumer(s): ______________

Address of consumer(s): ____________________

E-mail: _____________________________________

Date: _______________________________________

Signature of consumer(s) (only if this form is submitted on paper):