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Terms and conditions of use
Rules of the ARM Shop online store updated on 10.03.2025
§1 General provisions
§2 Registration and Orders
§3 Prices and payment methods
§4 Forms of delivery and execution
§5 Right to withdraw from the contract
§6 Complaint about the Goods
§7 Newsletter
§8 Rebate Program
§9 Personal data protection
§10 Trademark and distribution
§11 Information about cookies
§12 Terms and conditions of providing services by electronic means
§13 Final provisions
§1 General provisions
1. These Rules describe the guidelines for making transactions in the ARM Shop online store operating at the URL https://www.shop.medycynaludowa.com which is run by:
The Academy of Regenerative Medicine, Plac Dworcowy 2G, 58-160 Świebodzice
tax ID:8842544905, REGON 380424174,
Entered in the Register of Entrepreneurs CEIDG (Central Register and Information on Economic Activity of the Republic of Poland)
hereinafter referred to as „ARM Shop” or “Seller”
2. Glossary of terms used in these regulations:
Order processing time - the time during which the Seller will complete the order and send it via Poczta Polska or courier to the address provided by the Customer;
Working days - all days of the week from Monday to Friday, excluding public holidays;
Customer - a natural person, as well as a legal person or an organizational unit without legal personality, to whom the legal provisions grant legal capacity that uses the online store, especially that, on the terms set out in these Rules, places an order through the Online Store;
Civil Code - the Act of April 23, 1964 (Journal of Laws No. 16, item 93, as amended);
Consumer - a Customer who is a natural person who performs legal action with the Seller, which is not directly related to his business or professional activity, in particular who places an order in the Online Store or makes a reservation via the Online Store;
Newsletter - electronic information messages periodically sent by the Seller, which include, among others information on the Online Store offer and promotions;
Online Store (Store) - a store operating at the aforementioned URL, in which its users can purchase products offered by the Seller via the Internet;
Goods - products offered for sale available in the Online Store;
Sales contract - a contract concluded outside the business premises or remotely within the meaning of the Act on consumer rights of 30th of May 2014 (Journal of Laws of 2014, item 827);
Order - an order for Good or Goods placed by the Customer in the Store in accordance with these Rules.
3. Information about the Goods provided on the Store's websites, in particular their descriptions, technical and performance parameters as well as prices, constitute an invitation to conclude a contract, within the meaning of art. 71 of the Civil Code.
4. Customers can access these Rules at any time via the link on the homepage of the store
https://www.shop.medycynaludowa.com/regulamin and download it and print it.
5. The ARM Shop sells Goods to domestic and foreign Customers via the Internet and orders their delivery using the services of Poczta Polska and courier companies.
6. Copyrights to the Online Store and its content, including photos, belong to ARM Shop. No part of a publication or store may be copied or transmitted in any form by electronic, mechanical, photocopying or other media without the prior consent of the copyright owner. (Act of 4 February 1994 on copyright and related rights).
§2 Registration and placing orders
1. If you want to place an order in the online store, please comply with the following procedure:
a) register in the store *.
b) log in using the password received during registration,
c)place an order for the selected product.
* Orders placed as a guest (without registration) are also accepted.
2. The login and password are confidential.
3. An indispensable element of the ordering procedure is that the Customer has read and accepted these Rules, which the Customer confirms by checking the appropriate box before finalizing the order. The Customer's lack of acceptance of these Rules during the ordering procedure makes it impossible to use the option of purchasing goods via the Online Store.
4. During the ordering procedure - until you press the "Confirm order, Placing an order is associated with the payment obligation" button, the Customer has the option of modifying the order, in particular in terms of product selection, area of delivery, payment method, data provided in the order form. To modify the order in terms of selection, press the "Edit" button visible on the Online Store website during the ordering procedure.
5. Placing an order takes place after completing the order, selecting the delivery area, payment method and completing the order form. Placing an order is done by pressing the "Confirm Order" button by the Customer. An order placed via the Online Store entails the obligation to pay.
6. Placing an order by the Customer means submitting an offer to the Seller to conclude a Contract of Sale of the Good which is the subject of the order.
7. After placing the Order, the Customer receives an email confirming that the order has arrived at the store. If for any reason you do not receive it, please contact us by e-mail at [email protected]
8. Performance of the order takes place upon:
a) for orders paid on delivery - immediately;
b) for orders paid by bank transfer or via the electronic payment system - after the Customer's payment has been credited to the Seller's account;
c) for credit card - card authorization.
9. Before shipping the goods, an invoice or VAT invoice is issued for each order.
10. The Customer may make changes to the order until the invoice is issued.
11. The Customer may withdraw the placed order in its entirety until it is sent.
12. Placing an order is tantamount to:
a) consenting to the conclusion of the sales contract,
b) a statement of knowledge of the store's regulations and compliance with them.
13. In case of problems with the operation of the store or its work, please contact us via:
e-mail: [email protected], phone +48 74 300 38 16
§3 Prices and payment forms
1. All prices of Goods posted on the Store's website:
a) include VAT and are given in Polish zlotys;
b) do not include information on shipping costs;
2. The price given next to the Good is binding from the moment the Customer places the order and the Customer receives confirmation of the Order being processed.
3. Information on the total value of the order including shipping costs is presented after the Customer has chosen the form of delivery and the payment method (see §4).
4. The Seller reserves the right to change the prices of the Goods on offer, introduce new Goods to the Online Store offer, carry out and cancel all types of promotional campaigns and sales. The entitlement referred to in the previous sentence does not affect orders placed before the date of entry into force of the price change, terms of promotional campaigns or sales and such orders will be executed on the basis of the current rules.
5. Payments for the ordered Goods can be made:
a) in cash on delivery - the money is paid by the Polish Post Office or Courier to the bank account indicated by the Seller,
b) by transfer to a bank account - payment to the data provided in the order:
The Academy of Regenerative Medicine
Plac Dworcowy 2G,
58-160 Świebodzice
tax ID: PL8842544905
PL 55 1240 1952 1111 0011 4675 8734 (PLN)
PL 60 1240 1952 1978 0011 4675 8750 (EUR)
PL 24 1240 1952 1787 0011 4675 8763 (USD)
Bank Pekao S.A.
ul. Żubra 1, 01-066 Warszawa
SWIFT (BIC) PKOPPLPW
c) by electronic transfer using the Tpay.com or Axepta BNP Paribas or PayPal services - Payment methods BLIK, Quick Transfer, Visa and Mastercard, Apple Pay, Google Pay, Paypal.
6. Payment deadline for ordered Goods, in the case of choosing the payment method referred to in par. 5 let. b) and c) above is 7 business days from the date of concluding the Sales contract. Failure to pay is a condition for automatic termination of the Sales Contract.
7. It is not possible to combine the various payment methods listed in paragraph 5 when paying for one order.
§4 Delivery forms and Order processing
1. After the Customer receives confirmation of the Order, the process of the Order processing by the Store begins.
2. Delivery of Goods ordered in the Online Store takes place via the Polish Post Office or courier.
3. The current delivery price list is available in the Online Store.
4. Shipment of orders outside the European Union countries involves an additional paid export clearance. The cost of export clearance, depending on the destination country (e.g. Norway, Switzerland, Iceland, Canada), may vary. This cost is determined individually after placing the order. The Customer is informed about its amount. If the cost is not accepted by the Customer, the order is canceled and any payments previously made are returned.
5. Personal pickup at the company's office in Świebodzice is possible after placing an order and arranging for a pickup by phone.
6. In the event of a personal pickup declaration and no pickup within 14 days, the Order is automatically canceled and the Sales Contract is terminated.
7. The delivery time is usually from 1 to 3 business days from the moment of:
a) when the customer chooses payment on delivery – accepting the order,
b) when the customer makes a payment using Tpay.com or Axepta BNP Paribas or PayPal - receiving confirmation of making the payment or posting the payment on the account,
c) when the customer pays by transfer to the account- posting the payment on the account.
d) For the purpose of determination of the delivery time, orders placed from Friday from 14.00 until Sunday are treated as submitted on the Monday following the weekend.
e) In exceptional cases, and in particular in the case of periodic increased sales, the delivery period may be extended. The customer will be informed about the status of the Order.
Order execution means completing, packing and sending the shipment (the shipment leaving from the warehouse). The delivery time by the courier should be added to the delivery time (usually 1-2 business days).
8. In the event of unavailability of some of the Goods covered by the Order, the Customer is informed about the status of the order and decides how to implement it (partial implementation, extension of waiting time, cancellation of the entire order).
9. The Customer, when collecting the parcel with the Order, should check the condition of the parcel. If it is found that the packaging is damaged, we recommend making a damage report in the presence of the postman or courier. In this case, it will be the basis for submitting a complaint by the Seller to the carrier. Providing a damage report is not required to make a complaint by the Customer.
10. Receipts are issued for purchased products. In the case of a purchase for a company - please provide additional information with correct invoice details to the e-mail address: [email protected].
11. Orders placed but not paid are canceled after 14 days.
12. If the Customer selects the Delivery of the Order, the Goods are released to the Customer when the Seller releases the ordered Goods to the Supplier, eg a courier or another person indicated by the customer. The Customer authorizes the Supplier to collect and deliver the Goods to the Customer.
13. Orders delivered outside the EU may be subject to import duties and/or taxes over which The Academy of Regenerative Medicine has no control. These fees are the responsibility of the Customer. We recommend that you contact your local customs authorities for further information before ordering.
§5 The right to withdraw from the contract and returns
1. Pursuant to the Act of 30th of May 2014 on consumer rights (Journal of Laws of 2014, item 827, as amended), a Customer who has entered into a remote or off-premises contract may withdraw from it within 14 days without giving a reason and without incurring costs (except for the direct costs of returning the Goods) and return the product. To implement a goods return, you must attach a confirmation of purchase (check or invoice).
3. The Customer may withdraw from the contract by submitting a declaration of withdrawal to the Seller and send the return form to the e-mail: [email protected], which is attached as Annex 1 to these Regulations.
4. The Seller will confirm as soon as possible to the Customer the receipt of a statement of withdrawal from the contract by e-mail (provided when concluding the Sales Contract).
5. In the event of withdrawal from a remote contract, the contract is considered null and void. The Seller is obliged to immediately, not later than within 14 days from the date of receipt of the Customer's statement of withdrawal from the contract, return to the Customer all payments made by him, including the costs of delivery of the Goods. The seller reimburses the payment using the same method of payment as used by the Customer, unless the Customer has expressly agreed to a different method of reimbursement that does not involve any costs for him.
6. If the Seller does not propose that he collects the Goods from the Customer himself, the Seller may withhold the reimbursement of payments received from the Customer until receipt of the Goods or delivery by the Customer of proof of sending the Goods - depending on which event occurs first.
7. If the Customer chooses a method of delivery of the Goods other than the cheapest regular delivery method offered by the Seller, the Seller is not obliged to refund the additional costs incurred by the Customer.
8. The Customer is obliged to return the returned Goods to the Seller or to transfer the Goods to a person authorized by the Seller for immediate collection, but not later than 14 days from the day on which he withdrew from the contract. To meet the 14-day deadline, it is sufficient to return the Goods before its expiry. Please pack and secure the returned Goods so that they are not damaged during transport.
9. Returned Goods should be sent to the address: The Academy of Regenerative Medicine, Plac Dworcowy 2G, 58-160 Świebodzice.
10. The Customer bears only the direct costs of returning the Goods, unless the Seller has agreed to bear them.
11. The Customer is liable for a decrease in the value of the item as a result of using it in a way that goes beyond what is necessary to establish the nature, characteristics and functioning of the item.
12. The Seller additionally guarantees 100% satisfaction with the purchased goods. The Customer can unpack and check the product. In the event of resignation or dissatisfaction with the Goods received, we guarantee reimbursement of costs incurred (except for the direct cost of returning the Goods). However, the returned product should not demonstrate any wear.
13. According to art. 38 of the Act of 30th of April 2014 on consumer rights (Journal of Laws of 2014, item 827), the consumer is not entitled to withdraw from a remote contract:
1) for the provision of services, if the entrepreneur has fully performed the service with the express consent of the consumer, who was informed before the start of the service that after the performance of the service by the entrepreneur, the consumer will lose the right to withdraw from the contract;
2) in which the subject of the service is a non-prefabricated item, manufactured according to the consumer's specifications or serving to satisfy his individual needs;
3) in which the subject of the service is an item subject to rapid deterioration or having a short shelf life;
4) in which the subject of the service is an item delivered in a sealed package, which after opening the package cannot be returned due to health protection or hygiene reasons, if the packaging was opened after delivery;
5) in which the subject of the service are things that after delivery, due to their nature, are inseparably connected with other things.
14. Foodstuffs, herbal mixtures, cosmetics, probiotics, oils and other such products after opening the packaging, it is not possible to return.
For hygienic reasons, underwear is not returnable.
Medical devices are not returnable.
In the event of a product defect, please contact the store staff.
15. Entrepreneurs conducting business activity who make purchases for the company outside the seller's premises (via the Internet, telephone or by mail) may exercise the right to withdraw from the concluded contract on the same terms as consumers who are natural persons. The condition is, however, that such a purchase is not related to the conducted activity, and that the enterprise is not run in the form of a commercial law company. The deadline for withdrawal from the concluded contract is 14 days and is counted either from the moment of delivery of the goods or performance of the ordered service. Exclusions from the right to withdraw from the contract - when the entrepreneur buys goods for an individual order - manufactured according to his specifications, with a logo, to a specific size.
§6 Goods Complaint
1. The Seller has a legal obligation to deliver Goods without defects.
2. If the Goods received by the Customer are defective, the Customer may, at his option, exercise the rights granted under the guarantee on the indicated services or - independently - the rights available to him from the Seller under the warranty for defects in the Goods.
3. The Customer may submit his claims under the warranty by post to: The Academy of Regenerative Medicine, Plac Dworcowy 2G, 58-160 Świebodzice or by e-mail to: [email protected] with the note "complaint". Please attach the proof of purchase of the Goods to the complaint.
4. In order to speed up the processing of complaints, please provide in the content of the complaint a brief description of the reasons justifying the complaint and the Customer's contact details.
5. The Seller is liable to the Customer if the Goods sold have a physical or legal defect (warranty). The Customer may:
a. make a statement about the price reduction or withdrawal from the contract, unless the Seller immediately and without undue inconvenience to the Customer replaces the defective Product with a non-defective one or removes the defect. The reduced price should remain in proportion to the price resulting from the contract in which the value of the Good with the defect remains to the value of the Good without defect. The Customer may not withdraw from the contract if the defect of the Good is insignificant;
b. demand replacement of the Product free from defects or removal of the defect. The Seller is obliged to replace the defective Product with a product free of defects or remove the defect within a reasonable time without undue inconvenience to the Customer, subject to the conditions set out in the relevant provisions of the Civil Code.
6. If the Customer is a Consumer, instead of removing the defect proposed by the Seller, demand that the Product be replaced with a non-defective one or instead of replacing the Good, demand that the defect be removed, unless bringing the Good into compliance with the contract in the manner chosen by the Consumer is impossible or would require excessive costs in comparison with the method proposed by the Seller. When assessing the excess of costs, the value of the Good free from defects, the type and significance of the defect found are taken into account, as well as the inconvenience to which the Consumer would otherwise be exposed.
7. The Customer who exercises the warranty rights is obliged to deliver the defective Goods at the Seller's expense to the following address: The Academy of Regenerative Medicine, Plac Dworcowy 2G, 58-160 Świebodzice.
8. If the Customer who is a Consumer requests the exchange of the goods or removal of a defect or has submitted a statement on the price reduction, specifying the amount by which the price is to be reduced, and the Seller has not responded to this request within 14 days, it is considered that this request was considered justified.
9. The Seller is liable under the warranty if a physical defect is found within two years from the date of delivery of the item to the Customer. The claim for the removal of a defect or replacement of the Product free from defects expires after one year from the date of finding the defect, however, in the case of the purchase of Goods by the Consumer - the limitation period may not end before the period referred to in the first sentence.
§7 Newsletter
1. Customer has possibility to order newsletter from online shop.
2. Newsletter will be sent only to clients who order a newsletter ahead.
3. Customer agreeing newsletter has to agree on delivery using electronic way.
4. Customer has the right to unsubsribe from the newsletter at any time. To do this, please launch the link which can be found in newsletter mail or contact Seller using contact for or e-mail address: [email protected]
§8 Discount Program
(1) A customer may receive a discount by phone, email or other means.
§9 Personal data protection
9.1 The Administrator of personal data is The Academy of Regenerative Medicine with its registered office at Plac Dworcowy 2G,58-160 Świebodzice hereinafter referred to as the Administrator.
9.2 Obtaining and processing of personal data by the Administrator is done in order to:
(a) processing orders,
b) fulfillment of the Administrator's legal obligations, (issuance and storage of financial and accounting documents).
c) realization of legitimate interests (e.g. debt collection, handling of the complaint process, returns of goods, marketing of products and services of the Data Controller).
9.3 With the consent of the person, data may also be processed to send commercial information electronically, through the provided e-mail address or telephone.
9.4 Personal data about websites visited and purchases made will be processed in an automated manner in order to present a person with a personalized offer called profiling. In this regard, the Administrator uses so-called cookies. Detailed information about the use of cookies is contained in the Seller's Privacy Policy.
9.5 The consent referred to in sec. 9.3, can be withdrawn at any time. Contact us if you want to delete your account in the store through the contact form or e-mail address: [email protected].
9.6 The provision of data is fully voluntary, but the provision of some data is necessary for the performance of the sales contract and shipping. Failure to agree to provide the necessary data from the order form will result in the inability to process the order.
9.7 In pursuit of legitimate interests, personal data will be disclosed to third parties providing services to the Administrator. These will be entities belonging to the following categories:
- providers of website maintenance services, databases and other IT systems related to the Administrator,
- companies providing Internet marketing services, remarketing, sending electronic information.
Personal data are not transferred to entities outside the European Economic Area.
9.8 The entities indicated in para. 9.7 are obliged to protect data and to process personal data in accordance with the purposes specified by the Administrator.
9.9 A person has the right to access his/her personal data, to rectify them, to object to their processing, to delete them or to transfer them, subject to the reservation mentioned in 9.2 b) related to the Administrator's legal obligation.
9.10 At any time, a person also has the right to file a complaint with the President of the Office for Personal Data Protection and its legal successor.
9.11 All personal data will be processed for the purpose of operating The Academy of Regenerative Medicine online store in accordance with the provisions of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46/EC (General Data Protection Regulation).
§10 Trademark and distribution
10.1 The Seller owns a registered trademark for the word and figurative sign The Academy of Regenerative Medicine HARETSKI and, in accordance with Article 153(1) of the Industrial Property Law and the decision of the Patent Office, has acquired the exclusive right to use the trademark in a commercial and professional manner throughout the EU. The use of the trademark, especially further resale and use for promotional purposes (workshops, demonstrations, photo and video materials) without the consent of the owner is prohibited.
10.2 The Academy of Regenerative Medicine does not distribute its products in other online stores and does not sell its products in stationary stores.
10.3 The only channel for purchasing The Academy of Regenerative Medicine products is the website https://shop.medycynaludowa.com
§11 Information about cookies
11.1 Our Websites and Mobile Apps use cookies to deliver content and functionality that users are interested in. In addition, we use cookies for analytics and advertising purposes; you can change this in your browser settings or by using the [MORE SETTINGS] button. Please be advised that in order to optimize the content available on our site, to adapt it to your individual needs, we use information stored via cookies on users' terminal devices. You can control the cookies files using the settings of your web browser. Continued use of our website, without changing your browser settings, means that you accept the use of cookies.
11.2 The service collects automatically only the information contained in cookies. Cookies are text files that are stored in the service user's terminal device. They are intended for the use of the website pages. First of all, they contain the name of the website of their origin, its unique number, time of storage on the end device.
11.3 The website operator uses cookies to:
- matching the content of the website to the individual preferences of the user, first of all, these files recognize the user's device in order to display the site according to his preferences;
- preparation of statistics helping to learn about the preferences and behavior of users, analysis of these statistics is anonymous and allows to adjust the content and appearance of the site to prevailing trends, statistics are also used to assess the popularity of the site;
- possibility of logging into the site;
- maintaining the user's login on each subsequent page of the site.
11.4 The site uses two main types of files (cookies) - session and permanent. Session files are temporary; they are stored until you leave the site (by going to another page, logging out or closing your browser). Permanent files are stored on the user's end device until they are deleted by the user or for the time resulting from their settings.
11.5 The user may at any time change the settings of his/her browser to block the use of files (cookies) or each time obtain information about their placement on his/her device. Other available options can be checked in the settings of your web browser. Please note that most browsers are set by default to accept the storage of (cookies)files on your end device.
11.6 The scope of processed personal data are necessary for the performance of services, in terms of data entered by users of the Site in the relevant contact forms (e.g. name, surname, address data, e-mail address, etc.). Data processing time - up to 3 years.
§12 Terms and conditions of providing services electronically
12.1 The Service Provider shall provide services to the Client to the extent and under the conditions specified in the Regulations and in accordance with generally applicable laws.
12.2 The Client agrees to comply with the Regulations and generally applicable laws.
12.3 The use of services provided by the Service Provider electronically requires:
- Internet access;
- an active electronic mail address (e-mail);
- a web browser updated to the latest version;
- enabled cookies in the browser;
- enabled scripting in the browser.
12.4 The Customer using the services provided by the Service Provider electronically acknowledges that it is prohibited to:
- use the services provided by the Service Provider in a manner contrary to their intended use, contrary to the law and contrary to good morals, including in a manner that violates the legally protected rights of the Service Provider or third parties, in particular as regards the protection of personal rights, copyrights and the image of third parties;
- Transmission through the services provided by the Service Provider of content that is offensive, contrary to the law or morality, including content that violates the legally protected rights of the Service Provider or third parties, in particular to the extent that it includes the protection of personal rights, copyrights and the image of third parties;
- using the services provided by the Service Provider to publish advertisements and any information of a commercial nature, including sending unsolicited commercial information through the services provided by the Service Provider;
12.4 taking any action that may hinder or interfere with the provision of services by the Service Provider.
12.5 The Service Provider reserves the right to:
- refuse to provide services if the Client violates the Terms and Conditions or generally applicable laws, or if the Client takes actions that impede or interfere with the Service Provider's services.
- Temporarily or permanently discontinue the provision of Services, in particular due to ongoing maintenance work.
12.6 The Service Provider shall not be liable for:
- interruptions in access to services, covered by the provisions of the Terms and Conditions, resulting from necessary technical and administrative actions;
- interruptions and disruptions in the operation of the Internet;
- interruptions in access to services, covered by the provisions of the Regulations, in cases caused by force majeure;
- discontinuation of services to Service Recipients who have violated the Terms and Conditions or generally applicable laws;
- damages caused to third parties as a result of the use by the recipients of the services provided by the Service Provider in a manner contrary to the Terms and Conditions and universally applicable laws.
§13 Final Provisions
13.1 Matters not covered by these Regulations shall be governed by the provisions of generally applicable law, in particular the Civil Code, the provisions of the Act on Provision of Electronic Services and other relevant provisions of Polish law.
13.2 The Regulations have been updated as of May 24, 2018 and are available on the Store's website.
13.3 In the event of an amendment to these Regulations, all contracts, orders placed before the effective date of the amendment to the Regulations will be implemented in accordance with the Regulations as in effect on the date of conclusion of the contract, placing an order by the Customer.
13.4 Registered Customers who have given their consent will be notified of the changes to the Rules and Regulations and their scope by e-mail (to the e-mail indicated when registering or ordering) or by a message in the news on the ARM-SPA website. Changes will be made to adapt the Rules and Regulations to the current state of the law.
13.5 The current content of the Rules and Regulations is available to the Customers on the website of the Store in the tab 'Rules and Regulations', from where the Customers may at any time review, as well as make a printout. The Rules and Regulations are made available on the website in a form that allows obtaining, reproducing and recording the content of these Rules and Regulations by means of a data communications system used by the Customer. Recording, securing and making available the content of the agreement concluded through the Online Store is done by sending the content of the concluded agreement to the Client's e-mail address provided within the framework of the transaction made in the Online Store.
Appendix No. 1 to the Regulations
Form for withdrawal from the contract
(this form should be filled out and sent back only if you wish to withdraw from the contract)
Please send the goods back to the address:
THE ACADEMY OF REGENERATIVE MEDICINE
Alexander Haretski
Dworcowy Square 2G,
58-160 Swiebodzice
Contact:
Tel. +48 74 300 38 16 (Mon-Fri: 8:00am-3:00pm)
I hereby inform you of my withdrawal from the contract of sale of the following items (list of goods):
Date of conclusion of the contract(*) / receipt(*):
Consumer's name:
Consumer's address:
Consumer's signature:
(only if the form is sent in hard copy)
Date:
(*) Delete not necessary.