Terms and conditions for sale of goods to consumers via a website

As we can accept your order and make a legally enforceable agreement without further reference to you, you must read these terms and conditions to make sure that they contain all that you want and nothing that you are not happy with.

These Terms and Conditions will apply to the purchase of the goods by you (the Customer or you). We are Island Feather Ltd a company registered in England and Wales under number 10238342 whose registered office is at 19 Great Southsea Street, Southsea, Hampshire, PO53BY with email address customercare@islandfeather.com; (the Supplier or us or we).
These are the terms on which we sell all Goods to you. By ordering any of the Goods, you agree to be bound by these Terms and Conditions. By ordering any of the Services, you agree to be bound by these Terms and Conditions. You can only purchase the Goods from the Website if you are eligible to enter into a contract and are at least 18 years old.

Interpretation

Consumer means an individual acting for purposes which are wholly or mainly outside his or her trade, business, craft or profession;
Contract means the legally-binding agreement between you and us for the supply of the Goods;
Delivery Location means the Supplier's premises or other location where the Goods are to be supplied, as set out in the Order;
Durable Medium means paper or email, or any other medium that allows information to be addressed personally to the recipient, enables the recipient to store the information in a way accessible for future reference for a period that is long enough for the purposes of the information, and allows the unchanged reproduction of the information stored;
Goods means the goods advertised on the Website that we supply to you of the number and description as set out in the Order;
Order means the Customer's order for the Goods from the Supplier as submitted following the step by step process set out on the Website;
Privacy Policy means the terms which set out how we will deal with confidential and personal information received from you via the Website;
Website means our website www.islandfeather.com on which the Goods are advertised.

Goods

The description of the Goods is as set out in the Website, catalogues, brochures or other form of advertisement. Any description is for illustrative purposes only and there may be small discrepancies in the size and colour of the Goods supplied.
In the case of any Goods made to your special requirements, it is your responsibility to ensure that any information or specification you provide is accurate.
All Goods which appear on the Website are subject to availability.
We can make changes to the Goods which are necessary to comply with any applicable law or safety requirement. We will notify you of these changes.

Personal information and Registration

When registering to use the Website you must set up a username and password. You remain responsible for all actions taken under the chosen username and password and undertake not to disclose your username and password to anyone else and keep them secret.
We retain and use all information strictly under the Privacy Policy.
We may contact you by using e-mail or other electronic communication methods and by pre-paid post and you expressly agree to this.

Basis of Sale

The description of the Goods in our website does not constitute a contractual offer to sell the Goods. When an Order has been submitted on the Website, we can reject it for any reason, although we will try to tell you the reason without delay. The Customer may, prior to placing an Order, peruse the essential characteristics of the goods which they intend to order on the Web Site. However, the Customer acknowledges that the images of the goods are for illustrative purposes only. Although the Supplier has made every effort to display the colours accurately, the Supplier cannot guarantee that the Customer’s computer’s display of the colours accurately reflects the actual colour of the goods.
The Order process is set out on the Website. Each step allows you to check and amend any errors before submitting the Order. It is your responsibility to check that you have used the ordering process correctly.
A Contract will be formed for the sale of Goods ordered only when you receive an email from us confirming the Order (Order Confirmation). You must ensure that the Order Confirmation is complete and accurate and inform us immediately of any errors. We are not responsible for any inaccuracies in the Order placed by you. By placing an Order you agree to us giving you confirmation of the Contract by means of an email with all information in it (ie the Order Confirmation). You will receive the Order Confirmation within a reasonable time after making the Contract, but in any event not later than the delivery of any Goods supplied under the Contract.
Any quotation is valid for a maximum period of 30 days from its date, unless we expressly withdraw it at an earlier time.
No variation of the Contract, whether about description of the Goods, Fees or otherwise, can be made after it has been entered into unless the variation is agreed by the Customer and the Supplier in writing.
During the ordering procedure the Supplier will ask the Customer to confirm that the Order is correct before the Customer proceeds to the checkout. If the Order is not correct, the Customer can revisit the Order and correct the mistake before submitting the Order to the Supplier. It is the Customer’s responsibility to ensure that the Order is correct.
By placing an Order on the Web Site, the Customer confirms that:
he/she is not purchasing the goods for a commercial purpose as a trader; he/she is at least 18 years old; and the information provided by the Customer during the ordering procedure (including without limitation, title, first name, surname, phone number, email address, delivery and invoicing address) is accurate and complete.
We intend that these Terms and Conditions apply only to a Contract entered into by you as a Consumer. If this is not the case, you must tell us, so that we can provide you with a different contract with terms which are more appropriate for you and which might, in some respects, be better for you, eg. by giving you rights as a business.
The Customer must read and expressly accept this Agreement prior to placing any Order on the Web Site. Customers may save or print out this Agreement which applies to their Order. When Customers are ready to finalise an Order, they may print out a summary statement of such Order.
Once the Supplier receives an Order placed by the Customer, the Supplier shall (subject to the goods being available) send a detailed order acknowledgement message to the Customer stating the total amount being billed to the Customer including all taxes, as well as the amount of VAT which is being charged and the delivery terms applicable to the Order.
Any goods and their prices shall only apply to Orders placed by Customers as long as they are visible on the Web Site during the placing of an Order by a Customer.
The Supplier shall promptly notify the Customer by e-mail, should any goods that are the subject of an Order turn out to be unavailable once an Order has been placed by the Customer. In such case, the amount to be billed for the Customer’s Order shall be recalculated and the Customer shall be reimbursed for the amount of the unavailable goods. Should all the goods ordered by the Customer be unavailable, the Customer shall be notified by e-mail that the Supplier cannot accept the Order and shall be reimbursed for the total amount of the Order. The Supplier’s non- acceptance of the Customer’s Order shall not give any right to compensation for the Customer based on the unavailability of the expected goods. The Customer shall be free to place a new Order on the Web Site for other available goods.
The Customer’s online disclosure of his/her bank card number and final confirmation of the Order shall constitute evidence of the integrity of the Order and shall give rise to the Customer being liable to pay the entire value of the Order.
The Parties hereby agree that any data, information, files, dates and times on which the Web Site was viewed and on which any Orders were placed and any other data transmitted in digital form between the Parties shall constitute admissible and valid evidence which shall be enforceable and binding on the Parties and in any judicial procedure and shall have the same evidential force as a deed delivered under private seal.
The Parties hereby pledge not to challenge the admissibility, validity, enforceability or evidential value of the aforementioned electronic data elements based on the fact that they are electronic in nature. Unless proven otherwise, these elements shall be valid and binding on the Parties in the same way, under the same terms and with the same evidential value as any document which is drawn up, signed or stored in writing. The Supplier shall for as long as reasonably necessary store all Order Forms, Acknowledgements and invoices on a reliable and durable medium so as to retain an integral and durable copy thereof.
In the event that the Customer becomes aware of a fraudulent use of his/her bank card by a third party, the Customer should notify the Supplier as soon as possible by sending an e-mail to customer service, stating the number of the bank card involved and the date of the Order, and providing evidence of his/her identity. The provision of this information shall not give rise to any right to compensation of the Customer nor to any duty upon the Supplier to reimburse the Customer. Where applicable, the Customer may request compensation or reimbursement from the bank which issued his/her bank card in keeping with the provisions of the applicable laws and with the terms of the contract between the Customer and the bank.

Discount Codes or Vouchers

Any discount codes or vouchers which are acquired by a Customer in the course of prior purchases of goods from Island Feather Ltd may only be used by that Customer and shall not be transferable to third parties. They shall only be valid subject to the terms and conditions which are laid down by Island Feather Ltd and disclosed to the Customer, such as those concerning their period of validity, and may only be redeemed against goods. Discount Codes and Vouchers may not be used cumulatively with other Discount Codes and Vouchers. They may not under any circumstance be converted into their cash equivalent and paid or reimbursed to the Customer.
The value of a Discount Code or Voucher must be used and consumed in full as part of a single Order and may not therefore be divided between several Orders.
Should the value of a Discount Code or Voucher be lower than the value of the goods the Customer wishes to order including VAT but excluding shipping and delivery costs, the Customer shall have to pay the difference between the two amounts involved as well as the shipping and delivery costs of the goods ordered.
Should the value of a Discount Code or Voucher be greater than the value of the goods the Customer wishes to order including VAT but excluding shipping and delivery costs, the Order shall not be accepted and the Customer shall be given the option to continue shopping by selecting additional items.
Should the value of a Discount Code or Voucher be equal to the value of the goods the Customer wishes to order including VAT but excluding shipping and delivery costs, the Customer’s Order shall be accepted and the Customer shall only have to pay the shipping and delivery costs of the goods ordered.
If for any particular reason an Order is not accepted by the electronic payment validation server, the Customer shall be barred from using the Purchase Voucher during a period of 72 (seventy two) hours. Once this period has elapsed, the Discount Code or Voucher shall be reactivated and may be used by the Customer to place a new Order.

Price and Payment

By placing an Order, the Customer accepts the prices and descriptions of the goods which are offered for sale on the Web Site. If some of the prices shown for certain goods is incorrect, the Supplier will notify the Customer of any discrepancy prior to sending the Acknowledgement. Where the correct price is lower than the price stated on the Web Site, the Customer will be charged the lower amount. If the correct price is higher than the price stated on the Web Site, the Vendor will contact the Customer to check if the Customer would like to go ahead with the Order.
The prices which are quoted next to each item offered for sale shall be shown in Pounds sterling (£) and include Value Added Tax (VAT), but exclude shipping and delivery costs. The prices of the goods that are the subject of an Order shall include VAT at the rate applicable in the UK on the date that the Order is placed.
The Supplier shall be entitled to modify the sale prices of its goods at any time. Should one or more taxes or compulsory levies be imposed or modified from time to time, whether upwards or downwards, such changes may be passed on as part of the sale price of the goods on offer on the Web Site.
However, the Supplier shall only charge the Customer the prices and taxes indicated to the Customer set out in the Acknowledgement. Moreover, the Customer shall be informed of the costs of shipping and delivering their Orders upon checking their shopping baskets and upon placing their Orders.
The price of the Goods and any additional delivery or other charges is that set out on the Website at the date of the Order or such other price as we may agree in writing.
The currency used to pay for Orders by a Customer residing within the United Kingdom and which are delivered to the United Kingdom shall be priced and payable in Pounds sterling (£).
The Customer must pay for goods when it places the Order. The Customer may pay for his/her Orders online using any of the following cards: Visa, Mastercard, American Express and Discover by providing his/her card number and expiration date, as well as the three last digits of the number shown on the back of his/her bank card.
An immediate reimbursement on the Customer’s bank account in case of unavailability of a product shall not give any right to compensation to the Customer.
When paying for an Order, the Customer provides the Supplier with an implied warranty that he/she has the requisite authorisation to use the payment method he/she elected upon placing his/her Order. Any Acknowledgement issued by the Supplier shall be subject to approval of the Customer’s payment by the relevant electronic payment validation server. Should the Customer’s bank reject the payment, the Order shall not be accepted and there shall be no obligation on the Supplier to dispatch the goods. As part of the measures taken to prevent fraud over the Internet, the Supplier shall be entitled to transmit information concerning the Order and the Customer’s payment method to a third party for verification purposes.
The Supplier shall check any Orders which have been validated on the Web Site in conjunction with the bank in charge of handling the electronic payments. Thus the Supplier may verify any Order whose delivery address is different from the Customer’s billing address. In doing so, the Supplier may ask the Customer to provide further information and documents required for the Order to proceed: evidence of the fact that the Customer and/or the person whose name was provided does indeed reside at the delivery address, the Customer’s bank details, etc. These requests shall be forwarded to the Customer either by e-mail or over the telephone.
The bank account linked to the payment method used by the Customer shall be debited as from the finalisation of the Order by the Customer on the Web Site. The Supplier shall be entitled to suspend or cancel any Order and/or any delivery, whatever the nature or state of progress thereof, if any monies due by the Customer are not paid or if there are any other problems with the Customer’s payment. Should a Customer fail to pay or pay late for all or part of a previous Order, any subsequent Orders placed by the Customer may be refused and any pending deliveries for the Customer may be suspended. The Supplier shall notify the Customer of this situation.
For the purpose of ensuring the security and confidentiality of all payments made via the Web Site, the details of the Customer’s bank cards shall be encrypted using the SSL (Secure Socket Layer) protocol while they transit over the Internet.

Delivery

We will deliver the Goods, to the Delivery Location by the time or within the agreed period or, failing any agreement, without undue delay and, in any event, not more than 30 days after the day on which the Contract is entered into.
In any case, regardless of events beyond our control, if we do not deliver the Goods on time, you can (in addition to any other remedies) treat the Contract at an end if:
We have refused to deliver the Goods, or if delivery on time is essential taking into account all the relevant circumstances at the time the Contract was made, or you said to us before the Contract was made that delivery on time was essential; or after we have failed to deliver on time, you have specified a later period which is appropriate to the circumstances and we have not delivered within that period.
If you treat the Contract at an end, we will (in addition to other remedies) promptly return all payments made under the Contract.
If you were entitled to treat the Contract at an end, but do not do so, you are not prevented from cancelling the Order for any Goods or rejecting Goods that have been delivered and, if you do this, we will (in addition to other remedies) without delay return all payments made under the Contract for any such cancelled or rejected Goods. If the Goods have been delivered, you must return them to us or allow us to collect them from you and we will pay the costs of this.
We do not generally deliver to addresses outside England and Wales, Scotland, Northern Ireland, the Isle of Man and Channels Islands. If, however, we accept an Order for delivery outside that area, you may need to pay import duties or other taxes, as we will not pay them.
You agree we may deliver the Goods in installments if we suffer a shortage of stock or other genuine and fair reason, subject to the above provisions and provided you are not liable for extra charges.
If you or your nominee fail, through no fault of ours, to take delivery of the Goods at the Delivery Location, we may charge the reasonable costs of storing and redelivering them.
The Goods will become your responsibility from the completion of delivery or Customer collection. You must, if reasonably practicable, examine the Goods before accepting them.
The goods ordered shall be delivered by the transport operator to the postal address of the Customer set out in the Acknowledgement. The estimated delivery date shall be set out in the Acknowledgement depending on the delivery option chosen by the Customer (Standard, Express or collect point) and the Country to which the Order is being delivered.
The Supplier shall entrust the selected transport operator with the task of transporting the goods. Any Orders which are placed on a Friday, Saturday, Sunday or a public holiday in the UK shall be processed as of the following Monday or as of the next working day. The delivery timescales are expressed in working days and shall vary depending on the destination of the goods. Without prejudice to the provisions herein before and for information only, the estimated delivery times generally noted for the various forms of delivery are as follows:
3-4 working days for “Express” deliveries bound for addresses in the UK as from the confirmation of the Customer’s Order by the Supplier. In order to benefit from Express delivery, the Order must be placed by the Customer and confirmed by the Supplier before midday.
5-7 working days in the case of “Standard” deliveries bound for addresses in the UK as from the confirmation of the Customer’s Order by the Supplier.
The simple overrun of the delivery time does not give any right to compensation.
Delivery tracking Upon issuing an Acknowledgement, an order tracking number shall be provided to the Customer to enable the latter to track the progress of the delivery of his/her Order. The Customer may either:
Click on a hypertext link featuring the Order confirmation, or
Type the order tracking number of his/her Order in the parcel tracking area of carrier’s web site as well as the postcode of the delivery address.
Upon the “Express” delivery of the package, a delivery note shall be presented to the Customer who shall be asked to sign it. Should it prove impossible to deliver the package to the Customer for any reason whatsoever (e.g. the Customer’s absence, incorrect delivery address, address cannot be found, etc.), the delivery person shall transmit a non-delivery code to the Supplier and shall leave a note to the Customer stating that he/she attempted to deliver the parcel and indicating the process for finalising the delivery. If the Customer doesn’t collect the package by presenting his/her ID card 10 days after the note left to the Customer, the package will be returned to the Supplier.
Upon the “Standard” delivery, the package shall be presented to the Customer who shall not be asked to sign it. Should it prove impossible to deliver the package to the Customer (e.g. the Customer’s absence, incorrect delivery address, address cannot be found, etc.), the delivery person shall transmit a non-delivery code to the Supplier and shall leave a note to the Customer stating that he/she attempted to deliver the parcel and indicating the process for finalising the delivery. If the Customer doesn’t withdraw the package after 10 days, presenting his/her ID card, the package will be returned to the Supplier. The custom service will contact the Customer to establish whether he/she prefers to make a re-delivery or get reimbursed.

Risk and Title

Risk of damage to, or loss of, any Goods will pass to you when the Goods are delivered to you. You do not own the Goods until we have received payment in full. If full payment is overdue or a step occurs towards your bankruptcy, we can choose, by notice to cancel any delivery and end any right to use the Goods still owned by you, in which case you must return them or allow us to collect them.

Withdrawal and cancellation

You can withdraw the Order by telling us before the Contract is made, if you simply wish to change your mind and without giving us a reason, and without incurring any liability.
This is a distance contract (as defined below) which has the cancellation rights (Cancellation Rights) set out below. These Cancellation Rights, however, do not apply, to a contract for the following goods (with no others) in the following circumstances:
a) goods that are made to your specifications or are clearly personalised; b) goods which are liable to deteriorate or expire rapidly.
Also, the Cancellation Rights for a Contract cease to be available in the case of any sales contract, if the goods become mixed inseparably (according to their nature) with other items after delivery.
Subject as stated in these Terms and Conditions, you can cancel this contract within 14 days without giving any reason.
The cancellation period will expire after 14 days from the day on which you acquire, or a third party, other than the carrier indicated by you, acquires physical possession of the last of the Goods. In a contract for the supply of goods over time (ie subscriptions), the right to cancel will be 14 days after the first delivery.
To exercise the right to cancel, you must inform us of your decision to cancel this Contract by a clear statement setting out your decision (eg a letter sent by post, fax or email). You can use the attached model cancellation form, but it is not obligatory. In any event, you must be able to show clear evidence of when the cancellation was made, so you may decide to use the model cancellation form.
You can also electronically fill in and submit the model cancellation form or any other clear statement of the Customer's decision to cancel the Contract on our website www.islandfeather.com. If you use this option, we will communicate to you an acknowledgement of receipt of such a cancellation in a Durable Medium (eg by email) without delay.
To meet the cancellation deadline, it is sufficient for you to send your communication concerning your exercise of the right to cancel before the cancellation period has expired.

Effects of cancellation in the cancellation period

Except as set out below, if you cancel this Contract, we will reimburse to you all payments received from you, including the costs of delivery (except for the supplementary costs arising if you chose a type of delivery other than the least expensive type of standard delivery offered by us).

Deduction for Goods supplied

We may make a deduction from the reimbursement for loss in value of any Goods supplied, if the loss is the result of unnecessary handling by you (ie handling the Goods beyond what is necessary to establish the nature, characteristics and functioning of the Goods: eg it goes beyond the sort of handling that might be reasonably allowed in a shop). This is because you are liable for that loss and, if that deduction is not made, you must pay us the amount of that loss.

Timing of reimbursement

If we have not offered to collect the Goods, we will make the reimbursement without undue delay, and not later than: 14 days after the day we receive back from you any Goods supplied, or (if earlier) 14 days after the day you provide evidence that you have sent back the Goods.
If we have offered to collect the Goods or if no Goods were supplied, we will make the reimbursement without undue delay, and not later than 14 days after the day on which we are informed about your decision to cancel this Contract.
We will make the reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise; in any event, you will not incur any fees as a result of the reimbursement.

Conformity and Guarantee

We have a legal duty to supply the Goods in conformity with the Contract, and will not have conformed if it does not meet the following obligation.
Upon delivery, the Goods will be of satisfactory quality; be reasonably fit for any particular purpose for which you buy the Goods which, before the Contract is made, you made known to us (unless you do not actually rely, or it is unreasonable for you to rely, on our skill and judgment) and be fit for any purpose held out by us or set out in the Contract; and conform to their description.
It is not a failure to conform if the failure has its origin in your materials.
We will immediately, or within a reasonable time, give you the benefit of the free guarantee given by the manufacturer of the Goods. Details of the guarantee, including the name and address of the manufacturer, the duration and territorial scope of the guarantee, are set out in the manufacturer's guarantee provided with the Goods. This guarantee will take effect at the time the Goods are delivered, and will not reduce your legal rights.

Successors and our sub-contractors

The Customer may only transfer its rights or obligations under this Agreement to another person if the Supplier agrees to such transfer in writing. The Supplier may transfer its rights and obligations under this Agreement at any time.
This Agreement is between the Supplier and the Customer. No other person shall have any rights to enforce any of its terms.
Each of the articles in this Agreement operates separately. If any court or relevant authority decides that any of them are unlawful or unenforceable, the remaining paragraphs will remain in full force and effect.
If the Supplier fails to insist upon the strict performance of any of the Customer’s obligations under the Agreement, or the Supplier does not enforce its rights against the Customer, or if the Supplier delays in doing so, that will not mean that the Supplier has waived its rights against the Customer, and will not mean that the Customer does not have to comply with those obligations. If a Supplier does waive its rights under this Agreement, it shall only do so in writing. Any waiver by the Supplier in respect of a Customer default shall not constitute a waiver of any subsequent default.

Circumstances beyond the control of either party

In the event of any failure by a party because of something beyond its reasonable control the party will advise the other party as soon as reasonably practicable; and the party's obligations will be suspended so far as is reasonable, provided that that party will act reasonably, and the party will not be liable for any failure which it could not reasonably avoid, but this will not affect the Customer's above rights relating to delivery and any right to cancel, below.

Liability

If the Supplier fails to comply with this Agreement, the Supplier will be responsible for any loss or damage the Customer suffers that is a foreseeable result of the Supplier’s breach of contract or negligence. The Supplier shall not be responsible for any loss or damage that is not foreseeable. Loss or damage is foreseeable if they were an obvious consequence of the Supplier’s breach or if they were contemplated by the Parties at the time of placing the Order.
The Supplier only supplies goods for domestic and private use. Accordingly, the Supplier has no liability to the Customer for any loss of profit, business, business opportunity or business interruption.
Nothing in this Agreement is intended to exclude or limit the Supplier’s liability for:
A death or personal injury caused by Vendor’s negligence; fraud or fraudulent misrepresentation; any breach of terms implied by Section 12, 13, 14 and 15 of Sales of Goods Act 1979; and defective products under Consumer Protection Act 1987.
The Supplier will not be liable or responsible for any failure to perform, or delay in performance of, any of the Supplier’s obligations under this Agreement that is caused by any act or event outside of its reasonable control.
If any act or event outside of the Supplier’s reasonable control takes place that affects the performance of the Supplier’s obligations under this Agreement: a) the Supplier will contact the Customer as soon as reasonably possible to notify; and b) the Supplier’s obligations under the Agreement will be suspended and the time for performance will be extended for the duration of the event outside its reasonable control. In such circumstances, the Supplier shall arrange a new delivery date when the event outside its reasonable control is over.
The Customer may cancel any Order affected by an event outside the reasonable control of the Supplier which has continued for more than 30 (thirty) days and receive a full refund of all sums paid in respect of any goods that are the subject of that Order that have not been delivered.

Governing law, jurisdiction and complaints

This Agreement sets out the terms and conditions governing the sale of goods offered by the Supplier on the Web Site, between the Supplier and the Customer. This Agreement governs the conditions under which Orders are placed, paid for, tracked and delivered, and where applicable, the warranties which may be applicable to Orders and the Customer’s right to change his/her mind after placing an Order, in compliance with the terms of this Agreement and the law governing this Agreement.
The Supplier shall be entitled to alter its terms and conditions of sale at any time. The terms and conditions of sale governing the relationship between the Parties in respect of an Order shall be the version which was online at the time the Customer placed the Order and which was expressly accepted by the Customer upon placing the Order, those terms and conditions of sale constituting this Agreement as defined in the Preamble.
Applicable law, settlement of disputes and language of this Agreement
The Web Site, this Agreement and any Orders which are placed through the Web Site, as well as the performance thereof, shall be governed by English law. Any dispute arising in connection with the interpretation or performance of this Agreement shall be governed by the exclusive jurisdiction of the English courts.
Disputes can be submitted to the jurisdiction of the courts of England and Wales or, where the Customer lives in Scotland or Northern Ireland, in the courts of respectively Scotland or Northern Ireland.
We try to avoid any dispute, so we deal with complaints in the following way: Island Feather is dedicated to providing the highest level of customer care. It is important that the customer is completely satisfied with their purchase. If a dispute occurs customers should contact us to find a solution. We will aim to respond with an appropriate solution within 5 days.

Cancellation Form

To Island Feather Ltd 19 Great Southsea Street Southsea Hampshire PO53BY Email address: customercare@islandfeather.com

I/We[*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*], Ordered on [*]/received on [*]______________________(date received) Name of consumer(s): Address of consumer(s):

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

Date: