GENERAL TERMS AND CONDITIONS OF ONLINE SALE

1829 APP INDIVIDUAL CUSTOMERS

Abuse of alcohol is dangerous for your health. Consume in moderation. Consumption of alcohol during pregnancy, even in small quantities, can have serious consequences for a child’s health.

After creating your 1829 Account, orders can only be made through the App, not on the Website. 

Article 1. Definitions

IIn these General Terms and Conditions of Sale, the below terms mean the following:

1829 App: refers to the 1829 App, which is free to download using a smartphone and/or tablet from the App Store (Apple) and Android app platforms.

Sales T&Cs: refers to these General Terms and Conditions of Sale, which are applicable to the 1829 App.

Customer: A consumer, and non wine trade professional, who holds an 1829 Account and wishes to make purchases on the App.

1829 Account: refers to a User's personal account, which includes all the User's data integrated within the 1829 App.

Service: events and services offered on the 1829 App.

Product: Wines and other products available for sale on the 1829 App.

Website: refers to the website accessible at www.champagne-bollinger.com.

Article 2. Scope of the application - acceptance

Via the 1829 App, the CHAMPAGNE BOLLINGER company (referred to hereafter as "CHAMPAGNE BOLLINGER") offers rare and exclusive wines and special events that it has carefully selected.

Unless otherwise agreed in writing by CHAMPAGNE BOLLINGER, the following Sales T&Cs govern all orders placed on its 1829 App by consumers and non-professionals with an 1829 Account.

These Sales T&Cs exclude all other conditions, in particular those applicable to in-store sales or through other distribution and marketing channels. These Sales T&Cs can be accessed on the 1829 App and the Website at any time and, where applicable, shall prevail over any other version or any other contradictory document by CHAMPAGNE BOLLINGER.

The placement of any order on the 1829 App implies acceptance of these Sales T&Cs, which the Customer declares to have read and agreed to. These Sales T&Cs may be subject to later amendments. In this case, the applicable version is the one in force on the App at the date of order placement.

Article 3. Supply

Via the 1829 App, CHAMPAGNE BOLLINGER provides the Customer with an online store presenting the Products and/or illustrations or Services, without the photographs and/or graphics having any contractual value. The Customer must refer to the description of each Product/Service in order to understand its essential characteristics before placing an order. The Products listed for sale on the 1829 App are rare and exclusive Products, of which stock is very limited, as specified when an order is placed.

If a Product ordered is unavailable, CHAMPAGNE BOLLINGER is not required to offer a Product of equivalent quality and price to the Customer. CHAMPAGNE BOLLINGER will only reimburse the sum paid, within a period of 14 (fourteen) days, without giving rise to any right to further compensation. Ordering and packaging process: orders can only be made according to the quantities and packaging unit of the Product that is displayed on the 1829 App.

The Products/Services presented on the App are only available for purchase in mainland France. Contractual information is presented in French and in English. For delivery outside of Metropolitan France, the Customer can contact CHAMPAGNE BOLLINGER directly, by email at contact@champagne-bollinger.fr or by post at CHAMPAGNE BOLLINGER – Service Clients, 20 Boulevard du Maréchal de Lattre de Tassigny, 51160 Aÿ, France, so that the conditions of a potential order can be assessed.

Article 4. Orders

In accordance with Article L3342-1 of the French Public Health Code, which states that the sale of alcohol to minors is prohibited, the Customer certifies, by placing an order, that they are aged 18 years old or over on the date of the order and are legally able to purchase alcohol. The Customer is responsible for any false declarations.

Notwithstanding the provisions of Article 1587 of the French Civil Code, the sale of Products is concluded and final without approval of the Product by the Customer, who waives the right to make the purchase subject to prior tasting.

Order Process:

After creating their 1829 Account, it is the responsibility of the Customer to select the Products/Services they wish to order on the 1829 App, as follows:

•  Select the Product/Service and add it to the basket.

• Complete the order form. The selection of Products/Services chosen by the Customer is not guaranteed in cases of prolonged inactivity. If this occurs, the Customer will be invited to restart their Product selection from the beginning.

• Confirm the order details (first name and surname, contact information including email and telephone, delivery method, if required, and choice of payment method) and, if necessary, identify and correct any errors.

•  Accept the Sales T&Cs and confirm the order, the total price per Product as well as the order total by clicking on the “COMPLETE CHECKOUT” button. Confirmation of the order by the Customer implies acceptance of the Sales T&Cs and forms the basis of the contract. This confirmation constitutes proof of the sales contract.

• Follow the online payment server’s instructions to pay the order total or use the other payment methods that may be proposed at the time of the order.

•  The Customer will immediately receive an electronic acknowledgement of receipt containing the key order information, which acts as confirmation of the order (the “Order Confirmation”). Up until the order confirmation stage, the Customer will have the option to go back to the previous pages and to correct and modify their order and the information provided so far.

The sale will only be considered completed once the Order Confirmation has been emailed to the Customer by CHAMPAGNE BOLLINGER and payment has been received. Concerning the order of Services, CHAMPAGNE BOLLINGER specifies that they will confirm the order within six (6) days. In the absence of express confirmation of the order within this time period, the order of said Service will not be considered confirmed. In the context of visits alone, if CHAMPAGNE BOLLINGER is not able to fulfil the order (due to guest numbers, the weather, etc.), every effort will be taken to propose an alternative date.

Article 5. Order confirmation

In accordance with the provisions of Article L222-1 of the French Consumer Code, CHAMPAGNE BOLLINGER reserves the right to refuse or cancel any order from a Customer in the event of non-payment, late payment, partial payment, rejection of the payment method or opposition to the payment by the bank holding the account, but also in the event of a previous dispute relating to the payment of a previous order or in the event of an order that is abnormal, placed in bad faith or issued from countries not covered by these Sales T&Cs.

CHAMPAGNE BOLLINGER will inform the Customer should this occur.

CHAMPAGNE BOLLINGER does not intend to sell Products or Services available on the 1829 App to professionals, who have dedicated spaces with partner distributors, but only to consumers or non-professionals for their personal needs.

CHAMPAGNE BOLLINGER therefore reserves the right to refuse abnormal orders or orders in large quantities, after having notified the Customer in writing, without this entitling the Customer to damages or benefits of any kind.

If these Sales T&Cs are not adhered to by the Customer, CHAMPAGNE BOLLINGER reserves the right to cancel all or part of current orders or to suspend deliveries of goods, without this entitling the Customer to damages or benefits of any kind.

CHAMPAGNE BOLLINGER reserves the right to ask the Customer for additional guarantees, in particular with regards to their identity, for any order including one or more Products. It may also ask for payment guarantees for any order over €5,000 including all taxes.

Article 6. Pricing

Prices are given in euros, with all taxes included. Products and Services are provided at the current price listed on the 1829 App at the time the order is placed.

CHAMPAGNE BOLLINGER reserves the right to alter the prices listed on the 1829 App at any time. The price alteration is automatically applicable as of the date that it is published on the 1829 App.

Article 7. Payment Terms and Conditions

The price is payable upfront, in full, on the day the order is placed by the Customer, by means of the following secure payment methods:

• By Visa or Mastercard.

The exchange of payment data is encrypted via Stripe. Payment will be taken immediately from the bank card. Payments made by the Customer are only considered completed once the amounts due have actually been received by CHAMPAGNE BOLLINGER.

Late payment will make all amounts due on the Customer’s part immediately payable, without prejudice to any other action that CHAMPAGNE BOLLINGER may be entitled to take against the Customer in this respect. Any amount not paid on the due date will result in the application of late payment penalties at the statutory interest rate in force. In addition, CHAMPAGNE BOLLINGER reserves the right, in case of non-compliance with the payment terms and conditions listed above, to suspend or cancel the delivery of the Customer’s current orders.

The Customer will not be charged any additional costs beyond those incurred by CHAMPAGNE BOLLINGER regarding the use of a payment method.

Article 8. Service orders

8.1. Service fulfilment

CHAMPAGNE BOLLINGER makes various events available to Customers on the 1829 App. Descriptions of the proposed events appear on the 1829 App. CHAMPAGNE BOLLINGER specifies that they reserve the right to change/adapt the Services offered within various parameters (weather conditions, organiser unavailability, availability...). CHAMPAGNE BOLLINGER will inform the Customer of any changes as soon as possible. The Customer declares to have read and agreed to this. An in-app order can only be cancelled in the instance of the date of an event changing, in accordance with provisions of article 8.2, if alternative solutions offered by CHAMPAGNE BOLLINGER do not suit the needs of the customer. The Customer can request an invoice by contacting hospitality@champagne-bollinger.fr

8.2. Cancellation and refunds

In the event that CHAMPAGNE BOLLINGER is unable to provide a Service, the aforesaid will offer the Customer an alternative event. The Customer will receive a full refund for any cancellations made by CHAMPAGNE BOLLINGER, subject to the provisions of Article 10.2. No further compensation will be available.

In the event that a Customer cancels their order, they will be eligible for a refund under the following conditions:

  • For a visit (Discovery or Experience): the Customer can request a full refund for any cancellation placed 72 hours (3 working days) before a visit. 

  • For any other type of event: the Customer can request a full refund if the cancellation is requested at least 10 days before the date of the event. Cancellation and refund requests must be sent via email, and only to the following address: hospitality@champagne-bollinger.fr.

8.3. Customer Late Arrivals 

The Customer recognises that keeping to schedule is essential in order to guarantee the smooth running of Services for all Customers taking part.  

In the event that a Customer arrives more than 15 minutes late, CHAMPAGNE BOLLINGER reserves the right to refuse admission to the Service (visit or any other event) to facilitate the smooth running of the Service and to ensure it can respect its own commitments towards its customers (seamless running of the event, calm atmosphere, flow).

Customers who arrive later than the stipulated arrival time will therefore not be admitted to groups benefitting from the Service at any point during the event (lunch, specific activities, visit, etc.) nor will they be able to postpone their Service to another date or time.

The Customer also declares that they are aware, and that they fully accept, that no refund, whether partial or total, and/or any other form of compensation, will be offered by CHAMPAGNE BOLLINGER in the event of a late arrival. 

Article 9. Product Delivery

9.1. Delivery charges

CHAMPAGNE BOLLINGER offers free delivery for all orders within Metropolitan France. 

For delivery outside of Metropolitan France, the Customer can contact CHAMPAGNE BOLLINGER directly, either by email via contact@champagne-bollinger.fr, or by post: CHAMPAGNE BOLLINGER – Service Clients, 20 Boulevard du Maréchal de Lattre de Tassigny, 51160 Aÿ, France.

If the Customer makes a special request relating to the packaging or delivery of their order, which has been accepted in writing by CHAMPAGNE BOLLINGER, all related costs will be subject to a specific additional invoice based on an estimate which has been accepted in writing by the Customer.

9.2. Delivery times

Customer orders will be delivered within Metropolitan France within 15 days of the order being placed to the address indicated by the Customer when placing the order within the Application, subject to Customer availability.

Delivery means the transfer of physical possession of the Products to the Customer. Excepting special circumstances, or in the event that one or more Products are unavailable, ordered Products will be shipped in a single delivery.

If Products within a single order have different delivery times, the longest delivery time will be applied for the entire order. 

CHAMPAGNE BOLLINGER endeavours to deliver Products or perform Services within the timeframes specified above. However, these timeframes are guidelines and may be subject to change.

However, if the ordered Products have not been delivered within 30 days of the indicated delivery date, excepting force majeure or the fault of the customer, the customer may request the cancellation of the sale in writing, under the conditions set out in articles L.216-2, 1.216-3 and L.241-4 of the French Consumer Code. The total sum paid by the Customer will then be returned a maximum of 14 days after the cancellation of the contract, with the exclusion of any damages or deductions.

9.3. Transport conditions

The Customer is advised to check the condition of the Product on delivery.

Products are delivered by an independent carrier to the address provided by the Customer at the time of ordering, a location which must be easily accessible to the carrier. The Customer must ensure that they are present at the time of delivery and provide CHAMPAGNE BOLLINGER or the carrier with all the necessary information required for the smooth running of said delivery.

9.4. Click and collect  

The Client may collect their order free of charge from the CHAMPAGNE BOLLINGER shop: 20 Boulevard Maréchal de Lattre 51160 Aÿ – France.

In choosing this option, the Customer must select a collection date via a dedicated appointment calendar on the Application.  The Client will be unable to select a collection date within 12 days of placing the order, to allow CHAMPAGNE BOLLINGER the time to prepare it. After this time, the Client will be able to choose a collection date within a 12-month rolling period. 

Orders may be collected by appointment only, in accordance with the date selected by the Customer within the Application and within the shop’s opening hours: Monday - Friday from 10:00-12:00 and 14:00-17:00. 

Orders will be held in the shop for up to ten days following the agreed collection date. In the event that the Customer does not collect their order during this time, the order will be cancelled, and the Customer will be refunded for the full amount paid. 

9.5. Transfer of ownership - Transfer of risks

CHAMPAGNE BOLLINGER reserves the right to retain ownership of the delivered Products until payment of PRINCIPAL AND SECONDARY CHARGES has been received in full: PAYMENT UNDERSTOOD AS ACTUAL RECEIPT OF ALL AMOUNTS OWED. 

A Customer in possession of Products which have not been paid for in full commits to keeping them in perfect condition, to informing CHAMPAGNE BOLLINGER where they are being stored and to ensure they remain available to CHAMPAGNE BOLLINGER.

Irrespective of the date of transfer of ownership of the Products, the transfer of risk of loss or deterioration of the aforesaid Products shall only be transferred to the Customer when they take physical possession of the Products.

Therefore, the Products are transported at CHAMPAGNE BOLLINGER’s own risk.

Article 10. Right of withdrawal

10.1. Product orders

The Customer has a period of 14 (fourteen) calendar days from the date of receipt of the Products to exercise their right of withdrawal vis-à-vis CHAMPAGNE BOLLINGER without having to give any reason or pay any penalty, for the purpose of exchange or refund, provided that the Products are returned in their original packaging and in perfect condition.

Returns must be made in their original condition and complete with original packaging and any accessories, allowing their return to sale in new condition, and should be accompanied by the purchase invoice. Damaged, opened, dirty or incomplete Products will not be accepted.

The right of withdrawal can be exercised by written request to CHAMPAGNE BOLLINGER using the withdrawal form attached to the invoice or any other unambiguous statement expressing the desire to withdraw, sent to the following addresses: - Postal Address: Champagne Bollinger, Service Clients, 20 Boulevard du Maréchal de Lattre Tassigny, 51160 Aÿ, France. Email: contact@champagne-bollinger.fr. If the right of withdrawal is exercised within the aforementioned period, the price of the Products will be refunded, but the cost of returning them are to be borne by the Customer. The exchange (subject to availability) or refund will be made within 14 (fourteen) days of receipt by CHAMPAGNE BOLLINGER of the Products returned by the Customer under the conditions set out in this section. In accordance with Article L221-28 of the French Consumer Code, the right of withdrawal cannot be exercised, in particular, for contracts for the supply of goods that have been made according to the consumer’s specifications or that have been distinctly personalised, of goods likely to deteriorate or expire quickly, or of goods that were unsealed by the consumer after delivery and cannot be returned for hygiene or health protection reasons.

10.2. Service orders

In accordance with Article L.221-28-12 of the French Consumer Code, the right of withdrawal cannot be exercised for contracts: "for the supply of services fully executed before the end of the withdrawal period and whose execution started after the consumer's express prior agreement, with an express waiver of the right to withdrawal"; "for the provision of accommodation, with the exception of residential accommodation, the transport of goods, car rental, catering or leisure activities which must be provided within a specified date or period"

Article 11. Seller’s liability – guarantee 

11.1. Product orders

CHAMPAGNE BOLLINGER guarantees that the Products sold on the 1829 App comply with regulations in force in France. Products are only intended for the Customer’s personal use and not for professional purposes.

Without additional payment and irrespective of the right of withdrawal, products provided by CHAMPAGNE BOLLINGER shall ipso facto come with the following in accordance with statutory provisions: the legal guarantee of conformity, for evidently defective, spoiled or damaged Products or those that do not correspond to the order and; the legal guarantee against hidden defects resulting from a material, design or manufacturing defect affecting the delivered Products making them unsuitable for use under the conditions and according to the stipulations outlined below.

11.2. Service orders

CHAMPAGNE BOLLINGER cannot be held liable if they are not able to carry out a Service, or if they perform it poorly, due either to the fault of the Customer, or to the insurmountable and unforeseeable failings of a third party, or in the event of a force majeure.

CHAMPAGNE BOLLINGER can in no circumstances be held liable for any harm befalling a Customer as the result of non-compliance with visit rules or the conditions in which Services are performed. 

REMINDER OF STATUTORY PROVISIONS:

Article L217-4 of the French Consumer Code: “The seller is obliged to deliver a good in conformity with the contract and shall be liable for any lack of conformity existing at the time of delivery. The seller shall also be liable for any lack of conformity resulting from the packaging, the assembly instructions, or the installation when the latter has been put in their charge in the contract or has been carried out under their responsibility.” 

Article L217-5 of the French Consumer Code:

To conform with the contract, the goods must:

1° - Be suitable for the purpose usually expected of similar goods and, if applicable: •correspond to the description given by the seller and have the qualities that the seller has presented to the buyer in the form of a sample or model; •have the qualities that a buyer can legitimately expect in view of public statements made by the seller, the producer or their representative, particularly in advertising or labelling.

2° - Or have the characteristics defined by mutual agreement between the parties or be suitable for any special use sought by the buyer, brought to the attention of the seller and accepted by the latter.” Article L217-12 of the French Consumer Code: “Claims relating to lack of conformity are limited to a period of 2 (two) years from the delivery of the goods.” Article 1641 of the French Civil Code: “The seller is liable for any hidden defects of the item sold that make it unsuitable for the purpose for which it is intended or that impair this use to the extent that the buyer would not have acquired it, or would have only given a lower price for it, if they had known about them.”

Article 1648 (Paragraph 1) of the French Civil Code: “Claims relating to redhibitory defects must be made by the purchaser within 2 (two) years of the discovery of the defect.” 

In order to assert their rights, the Customer must inform CHAMPAGNE BOLLINGER in writing of the non-conformity and/or hidden defects of the Products without delay and at the latest within 7 (seven) days from the delivery of the Products. The Customer must return the defective Products in the state in which they were received with all components (possible accessories, packaging, etc.). 

CHAMPAGNE BOLLINGER will refund or replace (subject to availability) the Products ordered. The costs of returning the Products shall be borne by the Customer. These costs vary according to the weight of the package. Estimated costs reach a maximum of around EUR 50 in Metropolitan France. CHAMPAGNE BOLLINGER cannot be held responsible for the inaccuracy of estimated shipping costs. The refunds of the Products judged not in conformity or defective will be carried out as soon as possible and at the latest within 14 (fourteen) days following verification of the non-conformity or hidden defect by CHAMPAGNE BOLLINGER. The refund will be given by crediting the Customer’s bank account or by bank cheque sent to the Customer. CHAMPAGNE BOLLINGER shall not be liable in the following cases: -Non-compliance with the legislation of the country in which the Products are used, which is the Customer’s responsibility to check, - Misuse, use for professional purposes, negligence or incorrect preservation or storage on the part of the Customer (for example in the case of abnormal aging of the Products), accident, or force majeure.

Article 12. Extended Producer Responsibility  

In accordance with Article L.541-10-1 of the French Environmental Code, CHAMPAGNE BOLLINGER is required to contribute to the prevention and management of waste relating to the products they commercialise. 

CHAMPAGNE BOLLINGER is a member of the Comité Champagne (SIRET 78038582900012) and holder of unique identifier: FR246127_01QEKR.

This identifier certifies that CHAMPAGNE BOLLINGER is registered with the administrative authority as a producer subject to the principal of extended producer responsibility relating to articles L.541-10 and following the Environment Code.

Article 13. Force majeure

CHAMPAGNE BOLLINGER may be released from all or part of its obligations, without being held liable for any damages incurred or associated benefits, should fortuitous events or force majeure occur that prevent or delay either the production or delivery of Products, or some of their components, or the execution of Services.  Cases of force majeure include: abnormal weather conditions (frost, heat wave, drought, coulure, etc.), fires, floods, storms, serious accidents involving equipment or machinery, conscription, war, epidemics, pandemics, major health crises, active circulation of a virus, the implementation of measures recommended by administrative bodies in the context of a health crisis, administrative closures, transport interruptions, shortage of raw materials, changes in laws or customs regulations relevant to the Products, and strikes, whether these events have a total or partial impact on the activities of CHAMPAGNE BOLLINGER or its suppliers, as well as – more generally – any cause beyond the control of CHAMPAGNE BOLLINGER.

CHAMPAGNE BOLLINGER undertakes to keep the Customer informed of the occurrence and consequences of a case of force majeure.

The contract binding CHAMPAGNE BOLLINGER and the Client will therefore be suspended ipso jure, without compensation of any kind, from the date of the occurrence of the event to the date it ends.

In the event of force majeure impacting the Customer’s obligations, they will not be held liable for the non-execution, or lateness in execution, of one of these obligations, such as they are described herein, resulting from a case of force majeure beyond their control.

Article 14. Telephone marketing 

In accordance with the provisions of article L.223-2 of the French Consumer Code, the Customer is informed of their right to register with Bloctel, free of charge, to opt out of telemarketing calls.

Article 15. Miscellaneous

The nullity of one of the clauses of the Sales T&Cs, particularly as a result of the application of a law or regulation or following a decision of a competent court that has become final, shall not lead to the nullity of the other clauses of the Sales T&Cs, which shall retain their full effect and scope between the parties.

If CHAMPAGNE BOLLINGER does not, at a given time, exert whichever one of the clauses of the Sales T&Cs and/or challenge a failure on the Customer’s part to meet whichever one of their contractual obligations, this cannot be interpreted as CHAMPAGNE BOLLINGER waiving its right to invoke the said clause or contractual obligation at a later date.

Article 16. Dispute resolution

By express agreement between the parties, these Sales T&Cs and the activities resulting from them are subject to French law. The original language of these Sales T&Cs is French. In the event that they are translated into one or more foreign languages, the French text will prevail in the event of a dispute.

In the event of a dispute, the Customer must first contact CHAMPAGNE BOLLINGER customer service by calling +33 (0) 3 26 53 33 66 (toll-free from landlines in Metropolitan France), available between 9 a.m. and 12 p.m. and between 2 p.m. and 5 p.m. from Monday to Friday except on public holidays, by emailing contact@champagne-bollinger.fr, or by post addressed to CHAMPAGNE BOLLINGER – Service Clients, 20 Boulevard du Maréchal de Lattre de Tassigny, 51160 Aÿ, France.

The Customer is hereby informed that they can in any case resort to conventional mediation, in particular with the French Commission for Consumer Mediation or with a mediator. The mediator is MEDIATION-NET. The mediator can be contacted directly online at www.mediation-net-consommation.com, by post addressed to MEDIATION-NET, 34 Rue des Épinettes, 75017, Paris, France, or by any alternative dispute resolution method (e.g. conciliation) in the event of a disagreement. The mediator must be contacted within a maximum of 1 (one) year from the initial complaint.

In addition, the Customer is hereby informed of the option to use the European online dispute resolution platform at the following web page:

https://ec.europa.eu/consumers/odr/main/?event=main.home2.show If any provision of these Terms and Conditions of Sale is found to be null and void, this shall not affect the validity or enforceability of the remaining provisions. All disputes arising from the purchase and sales activities concluded on the basis of these Sales T&Cs, whether in terms of their validity, interpretation, execution, cancellation, consequences or outcomes, shall be subject to the French Courts if they cannot be resolved amicably between CHAMPAGNE BOLLINGER and the Customer.

Article 17. Customer declarations

The Customer acknowledges having been informed, prior to placing the order and concluding the contract, in a clear and comprehensible manner, of these Sales T&Cs and of all the information listed in Article L221-5 of the French Consumer Code and more specifically the following information:

  • The essential characteristics of the Products sold 

  • The price of the Products and related expenses 

  • The period within which the Seller undertakes to deliver the Products 

  • All information concerning the identity of the Seller as well as their postal, electronic and telephone contact information 

  • Information relating to the legal guarantees as well as details on their implementation

  • The possible use of conventional mediation in the event of a dispute 

  • Information about the right of withdrawal, return shipping costs, termination terms and all other important contractual terms 

  • The accepted payment methods.

Withdrawal Form
For online customers

This form must be completed and returned only if the Customer wishes to withdraw from an order placed remotely on the 1829 App, excepting exclusions or limitations to the right of withdrawal according to the Sales T&Cs.

For the attention of:

CHAMPAGNE BOLLINGER

Service Clients

20 Boulevard du Maréchal de Lattre de Tassigny

51160 AY

FRANCE


I hereby give notice of withdrawal from the contract for the following order:

- Order date: ...........................................................................

- Products ordered: ..................................................................

- Order number: ..........................................................

- Customer name: ............................................................................

- Customer Address: .......................................................................


Customer signature:

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