Model Withdrawal Form — FizzUp

1. Addressee

To:

DB 77 CUW Sp. z o.o.

ul. Żółkiewskiego 31, 87-100 Toruń, Polska

E-mail: support@fizzup.ai

2. Withdrawal statement

I hereby give notice that I withdraw from the contract for the supply of the following digital service:

[FizzUp — subscription / plan name]

3. Order details

• Order date: …………………………………………
• Account e-mail: …………………………………………
• Order ID / invoice no.: …………………………………………
• Payment method: [Stripe / Apple / Google / other]

4. Consumer details

• First and last name: …………………………………………
• Address: …………………………………………
• E-mail: …………………………………………

5. Signature and date

Signature: …………………………………………

Date: …………………………………………