Terms and Conditions

Trading terms and conditions

These terms and conditions are the contract between you and Corrib Candles Website (“us”, “we”, etc). By visiting or using Corrib Candles Website, you agree to be bound by them.

I / We are Corrib Candles Website a company registered in Ireland number 265597. Our address is Lower Village Menlo, Galway city, Ireland. H91 K2P5

You are: Anyone who uses Corrib Candles Website.

Please read this agreement carefully and save it. If you do not agree with it, you should leave Corrib Candles Website immediately.

The terms and conditions:

1.            Definitions

In this agreement:


means any individual who, in connection with this agreement, is acting for a purpose which is outside his business.


means the textual, visual or audio content that is encountered on Corrib Candles Website. It may include, among other things: text, images, sounds, videos and animations.

“Extra Work”

means all of the work we do and materials we buy to prepare or produce Personalised Goods.


means any of the goods we offer for sale on Corrib Candles Website, or, if the context requires, goods we sell to you. It includes Personalised Goods.

"Intellectual Property"

means intellectual property of every sort, whether or not registered or registrable in any country, including intellectual property of kinds coming into existence after today; and including, among others, designs, copyrights, software, discoveries, know-how, together with all rights which are derived from those rights.


means display, exhibit, publish, distribute, transmit and/or disclose information, Content and/or other material on to Corrib Candles Website, and the phrases "Posted" and "Posting" shall be interpreted accordingly.

“Personalised Goods”

means Goods which have been subject to work or process to your specific order.

“Corrib Candles Website”

means any website of ours, and includes all web pages controlled by us.

2.            Interpretation

Unless the context clearly requires otherwise, the interpretation of this agreement shall be subject to the matters listed below.

2.1.        a reference to one gender shall include any or all genders and a reference to the singular may be interpreted where appropriate as a reference to the plural and vice versa.

2.2.        a reference to a person includes a human individual, a corporate entity and any organisation which is managed or controlled as a unit.

2.3.        the headings to the paragraphs of this agreement are inserted for convenience only and do not affect the interpretation.

2.4.        in the context of permission, “may not” in connection with an action of yours, means “must not”.

2.5.        any agreement by either party not to do or omit to do something includes an obligation not to allow some other person to do or omit to do that same thing.

2.6.        a reference to an act or regulation includes new law of substantially the same intent as the act or regulation referred to.

2.7.        in any indemnity, a reference to costs or expenses shall be construed as including the estimated cost of management time of the indemnified party.

2.8.        these terms and conditions apply to all supplies of Goods by us to you. They prevail over any terms proposed by you.

3.            Our contract with you

3.1.        This agreement contains the entire agreement between the parties and supersedes all previous agreements and understandings between the parties.

3.2.        Each party acknowledges that, in entering into this agreement, he does not rely on any representation, warranty, information or document or other term not forming part of this agreement.

3.3.        If you use Corrib Candles Website in any way and make an order on behalf of another person you warrant that you have full authority to do so and you accept personal responsibility for every act or omission by you.

3.4.        Because we rely on our suppliers, We do not guarantee that Goods advertised on Corrib Candles Website are available.

3.5.        We may change these terms from time to time. The terms that apply to you are those posted here on Corrib Candles Website on the day you order Goods. We advise you to print a copy for your records.

3.6.        The price of Goods may be changed by us at any time. We will never change a price so as to affect the price charged to you at the time when you buy those Goods.

3.7.        If in future, you buy Goods from us under any arrangement which does not involve your payment via Corrib Candles Website, these terms still apply so far as they can be applied.

4.            Acceptance of your order

4.1.        This paragraph applies to Goods which you buy from us as advertised, without change to your specific requirements.

4.2.        Your order is an offer to buy from us.


4.3.        We shall accept your order by e-mail confirmation. That is when our contract is made. Our message will also confirm details of your purchase.


4.4.        At any time before the Goods are despatched, we may decline to supply the Goods to you without giving any reason.

4.5.        If we do not have all of the Goods you order in stock, we will offer you alternatives. If this happens you may:

4.5.1        accept the alternatives we offer;

4.5.2        cancel all or part of your order.

5.            Extra Work and approval of Proof / Sample

5.1.        This paragraph applies to Personalised Goods.

5.2.        Our contract to supply Personalised Goods is a contract for both the supply of Goods and the Extra Work you have asked us to do.

5.3.        As some Personalised Goods orders are required to be completed by a certain date provided by you e.g.: wedding date, christening date. It’s important that your order is made at least four to five days ahead of the required date. This should allow us enough time to complete your order. Please add an extra two days for delivery. We will always do our best to insure your Personalised Goods arrive before the date required. We are not responsible for any delays that may arise during delivery. Please contact us about the time frame regarding bespoke and large Personalised Goods orders. We may decline last minute orders.

5.4.        Nothing said or done by us is an acceptance of an order until we confirm clear acceptance in writing, giving you details of our understanding of your exact requirements. At any point up until then, we may decline your order without giving any reason. From that time, we are both bound to these contract terms.

5.5.        Within one or time days (bespoke will take longer) of entering into this contract we will email a proof to you for approval. The proof will be emailed to the email address used by you during the checkout process.

5.6.        There is no extra charge for making small alterations to the specification of the Extra Work e.g. changing font, poem, colour etc. However, if you wish to make any large changes to the specification of the Extra Work, you must pay us the sum we estimate that the changes will cost us, based on our then current charging rates. Large changes entail: drawing new vector art, changing the size or shape of the design to fit a new object or candle.

5.7.        If you terminate this agreement before the Personalised Goods are complete, you agree to pay us for all of the Extra Work to the date of cancellation by you. In addition, you will pay us a mark-up of 30% of the total cost of Extra Work.

6.            Prices

6.1.        Prices of Goods are shown on Corrib Candles Website and in our showroom.

6.2.        Prices for bespoke Personalised Goods are available on enquiry, either through Corrib Candles Website email or by telephone 0877988482.

6.3.        It is possible that the price may have increased from that posted on Corrib Candles Website. If that happens, we will not dispatch the Goods until you have confirmed that you wish to buy at the new price.

6.4.        Prices include value added tax. If you show by your delivery address that you reside outside EU, we will refund to you the amount charged as VAT.

7.            Payment

7.1.        We will not split an order. We require the full price of your order before we will send any part of it.

7.2.        Bank charges by the receiving bank on payments to us will be borne by us. All other charges relating to payment in a currency other than Euro will be borne by you.

7.3.        Any information given by us in relation to exchange rates are approximate only and may vary from time to time.

7.4.        If, by mistake, we have under-priced Goods, we will not be liable to supply those Goods to you at the stated price, provided that we notify you before we dispatch it to you.

7.5.        The price of the Goods does not include the delivery charge which will be charged at the rates applicable at the date you place your order and which will be displayed on a page of Corrib Candles Website before we ask you to pay.

7.6.        If we owe you money (for this or any other reason), we will credit your credit or debit card as soon as reasonably practicable but in any event no later than 14 days from the date when we accept that repayment is due.

8.            Security of your credit card

We take care to make Corrib Candles Website safe for you to use.

8.1.        Card payments are not processed through pages controlled by us. We use one or more online payment service providers who will encrypt your card or bank account details in a secure environment.

9.            Cancellation and refunds

Please note that this paragraph does not apply to any Personalised Goods you order through Corrib Candles Website.

This paragraph applies if you buy as a consumer as defined in the European Union (Consumer Information, Cancellation and Other Rights) Regulations 2013. Provided the Regulations apply to the transaction concerned, then the following terms apply to the contract.

9.1.        We now inform you that information relating to all aspects of our Goods is not in this document but in our marketing material, whether that is in the medium of Corrib Candles Website or in hard copy.

9.2.        The following rules apply to cancellation of your order:

9.2.1        If you have ordered Goods, but not received them, you may cancel your order without giving a reason, at any time within 14 days of your order. You will have no obligation and we will return your money.

9.2.2        If you have ordered Goods, and received them, you may cancel your order at any time within 14 days of the date you received them. You must tell us that you wish to cancel. You must also send the Goods back to us within that same 14-day period.

9.2.3        We will return your money subject to the following conditions:           we receive the Goods in a condition in which we can re-sell them at full price, in new condition, with labels and packaging intact.           you comply with our procedure for returns and refunds. We cannot return your money unless we know who sent them.

9.3.        The option to cancel your order is not available:

9.3.1        if you purchase sealed goods which relate to health or hygiene, and they become unsealed after delivery, or cannot be re-sold for some other reason;

9.3.2        if they are a hard medium for a product in soft copy, which comes to you sealed and is returned to us unsealed.

9.3.3        If the Goods are somehow mixed with other goods so that we cannot identify or easily separate them.

9.4.        You are responsible for the cost of returning the Goods. We have no obligation to refund to you, your cost of re-packing and returning the Goods.

9.5.        In any of the above scenarios, we will return your money within 14 days.

10.       Liability for subsequent defects

10.1.     We will repair or replace Goods which show a defect. If you claim that the item is defective, the following conditions apply:

10.1.1     the defect must be reported to us within four weeks of becoming apparent;

10.1.2     the defect results only from faulty design or manufacture;

10.1.3     you have returned the defective Goods or parts to us if we have so requested.

10.2.     If we agree that we are liable, we will refund the cost of return carriage and will repair or replace the Goods free of charge.

10.3.     If we repair or replace the Goods, you have no additional claim against us either under this agreement or by statute or common law, in respect of the defect.

11.       Delivery

11.1.     Goods are normally delivered within 10 business days from the day you place an order to purchase the Goods. Personalised Goods may take longer depending on the size and complexity of the order.

11.2.     You may collect your Goods from our shop at Lower Village Menlo, Galway City. H91 K2P5. If you need any help with directions, phone 0877988482.

11.3.     Delivery of Goods will be made by the carrier to the address stipulated in your order. You must ensure that someone is present to accept delivery.

11.4.     If we are not able to deliver your Goods within 10 days of the date of your order, we shall notify you by e-mail to arrange another date for delivery.

11.5.     Goods are sent at our risk until signed for by you or by any other person at the address you have given to us unless you have instructed us in the order process that you wish us to leave the Goods without an acceptance signature (for example: “leave it in the garage”).

11.6.     Goods are sent by courier. We will send you a message by email to tell you when we have despatched your order.

11.7.     All Goods must be signed for on delivery by an adult aged 18 years or over. If no one of that age is at the address when the delivery is attempted the Goods may be retained by the driver. When your Goods arrive it is important that you check immediately the condition and quantity. If your Goods have been damaged in transit, you must refuse the delivery and immediately contact us so that we may dispatch a replacement quickly and minimise your inconvenience.

11.8.     Signing "Unchecked", "Not Checked" or similar is not acceptable.

11.9.     If we agree with you to deliver on a particular day or at a particular time, we will do our best to comply. But no time given is to be treated as contractual. So we are not liable to you for any expense or inconvenience you incur on account of delayed delivery or non-delivery.

11.10. Some Goods are so large and heavy that delivery times may be slightly longer. In this case, approximate delivery dates will be given when you place your order.

11.11. Time for delivery specified on the order, if any, is an estimate only and time shall not be of the essence.

11.12. We are happy for you to pick up Goods from our shop provided you make an appointment in advance and payment has been received into our bank. Payment on collection is also acceptable.

11.13. If you pick up Goods from our premises, then:

11.13.1 Goods are at your risk from the moment they are picked up by you or your Carrier from our shop / warehouse;

11.13.2 you agree that you are responsible for everything that happens after you take possession of the Goods, both on and off our premises, including damage to property of any sort, belonging to any person.

12.       Foreign taxes and duties

12.1.     If you are not in EU (European Union) country, we have no knowledge of, and no responsibility for, the laws in your country.

12.2.     You are responsible for purchasing Goods which you are lawfully able to import and for the payment of import duties and taxes of any kind levied in your country.

13.       Goods returned

These provisions apply in the event that you return any Goods to us for any reason except as a result of your cancellation under the Regulations.:

13.1.     We do not accept returns unless there was a defect in the Goods at the time of purchase, or we have agreed in correspondence that you may return them.

13.2.     Before you return Goods to us, please carefully re-read the instructions and check that you have assembled it correctly and complied with any provisions relating to the power supply, plugs and sockets.

13.3.     So far as possible, Goods should be returned:

13.3.1     with both Goods and all packaging as far as possible in their original condition;

13.3.2     securely wrapped;

13.3.3     at your risk and cost.

13.4.     You must tell us by email message to email that you would like to return Goods, specifying exactly what Goods and when purchased, and giving full details of the defect or other reason for return. If the Goods are damaged, please email a photograph of the damage. Please photograph the damage from multiple angles if possible.

13.5.     In returning faulty Goods please encloses with it a note clearly stating the fault and when it arises or arose.

13.6.     Most of the Goods are covered by the manufacturer's guarantee for a minimum of 12 months. Please first check the plug, fuse, batteries and the manufacturer's operating instructions.

13.7.     If delivery was made to Irish address, you are also protected by the Sale of Goods and Supply of Services Act 1980.

13.8.     If we agree that the Goods are faulty, we will:

13.8.1     refund the cost of return carriage;

13.8.2     repair or replace the Goods as we choose.

14.       European Union (Waste Electrical and Electronic Equipment) Regulations 2014

14.1.     These regulations provide that suppliers like high street shops and internet retailers must allow Consumers to return their waste equipment free of charge.

14.2.     Our obligation is to take back from you any electronic or electrical product when you buy a replacement product for similar use.

14.3.     If you wish to take advantage of this service, you must return your waste item within 15 days of buying your new one. You must pay the carriage cost to us.

15.       How we handle your Content

15.1.     Our privacy policy is strong and precise. It complies fully with the Data Protection Act 2018 which is at [link to privacy policy].

15.2.     If you Post Content to any public area of Corrib Candles Website, it becomes available to the public domain. We have no control over who sees it nor what anyone does with it.

15.3.     Posting Content of any sort does not change your ownership of the copyright in it. We have no claim over it and we will not protect your rights for you.

15.4.     You understand that you are personally responsible for your breach of someone else’s intellectual property rights, defamation, or any law, which may occur as a result of any Content having been Posted by you;

15.5.     You accept all risk and responsibility for determining whether any Content is in the public domain and not confidential.

15.6.     Please notify us of any security breach or unauthorised use of your account.

16.       Restrictions on what you may Post to Corrib Candles Website

We invite you to Post Content to Corrib Candles Website in several ways and for different purposes. We have to regulate your use of Corrib Candles Website to protect our business and our staff, to protect other users of Corrib Candles Website and to comply with the law. These provisions apply to all users of Corrib Candles Website.

We do not undertake to moderate or check every item Posted, but we do protect our business vigorously. If we believe Content Posted breaches the law, we shall co-operate fully with the law enforcement authorities in whatever ways we can.

You agree that you will not use or allow anyone else to use Corrib Candles Website to Post Content or undertake any activity which is or may:

16.1.     be unlawful, or tend to incite another person to commit a crime;

16.2.     consist in commercial audio, video or music files;

16.3.     be sexually explicit or pornographic;

16.4.     be likely to deceive any person or be used to impersonate any person, or to misrepresent your identity, age or affiliation with any person;

16.5.     give the impression that it emanates from us or that you are connected with us or that we have endorsed you or your business;

16.6.     be made on behalf of some other person, or impersonate another person;

16.7.     request or collect passwords or other personal information from another user without his permission, nor Post any unnecessary personal information about yourself;

16.8.     be used to sell any goods or services or for any other commercial use not intended by us, for yourself or for any other person. Examples are: sending private messages with a commercial purpose, or collecting information with the intention of passing it to a third party for his commercial use;

16.9.     include anything other than words (i.e. you will not include any symbols or photographs) except for a photograph of yourself in your profile in such place as we designate;

16.10. link to any of the material specified in this paragraph;

16.11. use distribution lists that include people who have not given specific permission to be included in such distribution process;

16.12. send age-inappropriate communications or Content to anyone under the age of 18.

17.       Your Posting: restricted content

In connection with the restrictions set out below, we may refuse or edit or remove a Posting which does not comply with these terms.

In addition to the restrictions set out above, a Posting must not contain:

17.1.     hyperlinks, other than those specifically authorised by us;

17.2.     keywords or words repeated, which are irrelevant to the Content Posted.

17.3.     the name, logo or trademark of any organisation other than yours.

17.4.     inaccurate, false, or misleading information;

18.       Removal of offensive Content

18.1.     For the avoidance of doubt, this paragraph is addressed to any person who comes on Corrib Candles Website for any purpose.

18.2.     We are under no obligation to monitor or record the activity of any user of Corrib Candles Website for any purpose, nor do we assume any responsibility to monitor or police Internet-related activities. However, we may do so without notice to you and without giving you a reason.

18.3.     If you are offended by any Content, the following procedure applies:

18.4.     your claim or complaint must be submitted to us in the form available on Corrib Candles Website, or contain the same information as that requested in our form. It must be sent to us by post or email.

18.4.1     we shall remove the offending Content as soon as we are reasonably able;

18.4.2     after we receive notice of a claim or complaint, we shall investigate so far as we alone decide;

18.4.3     we may re-instate the Content about which you have complained or we may not.

18.5.     In respect of any complaint made by you or any person on your behalf, whether using our form of complaint or not, you now irrevocably grant to us a licence to publish the complaint and all ensuing correspondence and communication, without limit.

18.6.     you now agree that if any complaint is made by you frivolously or vexatiously you will repay us the cost of our investigation including legal fees, if any.

19.       Security of Corrib Candles Website

If you violate Corrib Candles Website, we shall take legal action against you.

You now agree that you will not, and will not allow any other person to:

19.1.     modify, copy, or cause damage or unintended effect to any portion of Corrib Candles Website, or any software used within it.

19.2.     link to Corrib Candles Website in any way that would cause the appearance or presentation of Corrib Candles Website to be different from what would be seen by a user who accessed Corrib Candles Website by typing the URL into a standard browser;

19.3.     download any part of Corrib Candles Website, without our express written consent;

19.4.     collect or use any product listings, descriptions, prices, or product imagery;

19.5.     collect or use any information obtained from or about Corrib Candles Website or the Content except as intended by this agreement;

19.6.     aggregate, copy or duplicate in any manner any of the Content or information available from Corrib Candles Website, other than as permitted by this agreement or as is reasonably necessary for your use of Corrib Candles Website;

19.7.     share with a third party any login credentials to Corrib Candles Website;

19.8.     Despite the above terms, we now grant a licence to you to:

19.8.1     create a hyperlink to Corrib Candles Website for the purpose of promoting an interest common to both of us. You can do this without specific permission. This licence is conditional upon your not portraying us or any product or service in a false, misleading, derogatory, or otherwise offensive manner. You may not use any logo or other proprietary graphic or trademark of ours as part of the link without our express written consent.

19.8.2     you may copy the text of any page for your personal use in connection with the purpose of Corrib Candles Website.

20.       Disclaimers

20.1.     The law differs from one country to another. This paragraph applies to sales throughout the EU.

20.2.     All implied conditions, warranties and terms are excluded from this agreement. If in any jurisdiction an implied condition, warrant or term cannot be excluded, then this sub paragraph shall be deemed to be reduced in effect, only to the extent necessary to release that specific condition, warranty or term.

20.3.     We make no representation or warranty for:

20.3.1     any implied warranty or condition as to merchantability or fitness of the Goods for a particular purpose;

20.3.2     the adequacy or appropriateness of the Goods for your purpose.

20.4.     We claim no expert knowledge in any subject. We disclaim any obligation or liability to you arising directly or indirectly from information you take from Corrib Candles Website.

20.5.     You agree that in any circumstances when we may become liable to you, the limit of our liability is the amount you have paid us in the immediately preceding 12-month period for the Goods concerned.

20.6.     We shall not be liable to you for any loss or expense which is:

20.6.1     indirect or consequential loss; or

20.6.2     economic loss or other loss of turnover, profits, business or goodwill, even if such loss was reasonably foreseeable or we knew you might incur it.

20.7.     This paragraph (and any other paragraph which excludes or restricts our liability) applies to our directors, officers, employees, subcontractors, agents and affiliated companies as well as to us.

20.8.     If you become aware of any breach of any term of this agreement by any person, please tell us by email. We welcome your input but do not guarantee to agree with your judgement.

21.       Your account with us

21.1.     You agree that you have provided, and will continue to provide accurate, up to date, and complete information about yourself. We need this information to provide you with the Goods.

21.2.     If you use the website, you are responsible for maintaining the confidentiality of your account and password and for preventing any unauthorised person from using your computer.

21.3.     You agree to accept responsibility for all activities that occur under your account or password. You should tell us immediately if you believe some person has accessed your account without your authority and also log in to your account and change your password.

22.       Indemnity

You agree to indemnify us against all costs, claims and expense arising directly or indirectly from:

22.1.     your failure to comply with the law of any country;

22.2.     your breach of this agreement;

22.3.     any act, neglect or default by any agent, employee, licensee or customer of yours;

22.4.     a contractual claim arising from your use of the Goods;

22.5.     a breach of the intellectual property rights of any person.

23.       Intellectual Property

23.1.     Copyright works owned by you or a third party are unaffected by this agreement.

23.2.     The Intellectual Property in all work we do in the process leading to completion of the Personalised Goods and in the completed Personalised Goods belongs to us.

23.3.     If you change or create derivative versions of the Personalised Goods, the Intellectual Property in those changed or derived versions also belongs to us.

24.       Dispute resolution

In this paragraph the term “ADR Provider” means an approved body under the European Union (Alternative Dispute Resolution for Consumer Disputes) Regulations 2015.

The following terms apply in the event of a dispute between the parties:

24.1.     If you are not happy with our services or have any complaint, then you must tell us by email message to email.

24.2.     If a dispute is not settled as set out above, we hope you will agree to attempt to resolve it by engaging in good faith with us in a process of mediation or arbitration.

24.3.     We can propose an ADR Provider or will listen to your proposal. If you are in any way concerned, you should read the regulations at: http://ec.europa.eu/consumers/odr/.

25.       Miscellaneous matters

25.1.     When we communicate with you we do so by email. You agree that email communications are contractually binding in the same way as properly signed and dated paper sent by post.

25.2.     Where we provide goods or services without specific charge to you, then it (or they) is deemed to be provided free of charge, and not to be associated with any other goods or service for which a charge is made. Accordingly, there is neither contractual nor other obligation upon us in respect of those goods or that service.

25.3.     If any term or provision of this agreement is at any time held by any jurisdiction to be void, invalid or unenforceable, then it shall be treated as changed or reduced, only to the extent minimally necessary to bring it within the laws of that jurisdiction and to prevent it from being void and it shall be binding in that changed or reduced form. Subject to that, each provision shall be interpreted as severable and shall not in any way affect any other of these terms.

25.4.     The rights and obligations of the parties set out in this agreement shall pass to any permitted successor in title.

25.5.     Any obligation in this agreement intended to continue to have effect after termination or completion shall so continue.

25.6.     No failure or delay by any party to exercise any right, power or remedy will operate as a waiver of it nor indicate any intention to reduce that or any other right in the future.

25.7.     Any communication to be served on either party by the other shall be delivered by hand or sent by first class post or recorded delivery or by e-mail.

It shall be deemed to have been delivered:

if delivered by hand: on the day of delivery;

if sent by post to the correct address: within 72 hours of posting;

If sent by e-mail to the address from which the receiving party has last sent e-mail: within 24 hours if no notice of non-receipt has been received by the sender.

25.8.     So far as the law permits, and unless otherwise stated, this agreement does not give any right to any third party.

25.9.     We shall not be liable for any failure or delay in performance of this agreement which is caused by circumstances beyond our reasonable control, including any labour dispute between a party and its employees.

25.10. In the event of any conflict between any term of this agreement and the provisions of the constitution of a limited company or any comparable document intended to regulate any other corporate or collective body, then the terms of this agreement shall prevail.

25.11. The validity, construction and performance of this agreement shall be governed by the laws of Ireland and you agree that any dispute arising from it shall be litigated only in Ireland.


Notice of right of cancellation: Right to Cancel and Model Cancellation Form

Information about your statutory right to cancel

Your right to cancel

Under the European Union (Consumer Information, Cancellation and Other Rights) Regulations 2013, you have the right to cancel this contract within 14 days without giving any reason.

The cancellation period will expire 14 days after the contract was made. That means you can cancel before you have downloaded the product or we have delivered it to you.

Perishable, Bespoke and Personalised Goods cannot be cancelled.

How to cancel

To meet the cancellation deadline, it is enough for you to send your communication concerning your exercise of the right to cancel before the cancellation period has expired.

To exercise the right to cancel, you must inform us of your decision to cancel this contract by a clear statement, sent to us by post or e-mail.

You may use the attached model cancellation form, but you can use your own words as long as your intention is clear.

Cancellation form

To [here enter the trader’s name, geographical address and, where available, fax number and e-mail address are to be inserted by the trader]:

I/We hereby give notice that I/we cancel my/our contract of sale of the following products [enter details of goods and any reference].

Ordered on [date]/received on [date],

Name: [enter name or names in which the order was made],

Address: [enter your address],

Signature: (only if this form is notified on paper) Date: [date]