Terms & Conditions of Sale

1. THESE TERMS
1.1 What these terms cover. These are the terms and conditions on which we supply products to you, whether these are goods or services.
1.2 Why you should read them. Please read these terms carefully before you submit your order to us. These terms tell you who we are, how we will provide products to you, how you and we may change or end the contract, what to do if there is a problem and other important information. If you think that there is a mistake in these terms, please contact us to discuss.
1.3 You should print a copy of these terms or save them to your computer for future reference.
1.4 These terms were most recently updated on 21st September 2016.

2. INFORMATION ABOUT US AND HOW TO CONTACT US
2.1 Who we are. We are Le Mark Group Ltd a company registered in England and Wales. Our company registration number is 01761971 and our registered office is at Houghton Hill Industries Sawtry Way, Houghton, Huntingdon, Cambridgeshire, PE28 2DH. Our registered VAT number is GB 395772693. Le Mark Group Ltd trades as Le Mark Group, Le Mark Self-Adhesive, GafferTape.com and Dirty Rigger.
2.2 How to contact us. You can contact us by telephoning our customer service team at 01480 494540 or by writing to us at info@lemark.co.uk or Unit 1, Houghton Hill Industries, Sawtry Way, Houghton, Huntingdon, Cambridgeshire, PE28 2DH.
2.3 How we may contact you. If we have to contact you we will do so by telephone or by writing to you at the email address or postal address you provided to us in your order.
2.4 When we use the words “writing” or “written” in these terms, this includes emails.
2.5 Contacting us if you are a business. If you are a business and you wish to give us formal notice of any matter in accordance with these terms, please see clause 17.

3. OUR CONTRACT WITH YOU
3.1 Our acceptance of your order will take place when we email you to accept it, at which point a contract will come into existence between you and us.
3.2 If we are unable to accept your order, we will inform you of this and will not charge you for the product, or if payment has already been taken we will refund you via the original payment method. This might be because the product is out of stock, because of unexpected limits on our resources which we could not reasonably plan for, we have identified an error in the price or description of the product or because we are unable to meet a delivery deadline.

4. OUR PRODUCTS
4.1 The images of the products on our website are for illustrative purposes only. Although we have made every effort to display the colours accurately, we cannot guarantee that a device’s display of the colours accurately reflects the colour of the products. Your product may vary slightly from those images.
4.2 The packaging of the product may vary from that shown in images on our website.
4.3 If we are making the product to measurements you have given us you are responsible for ensuring that these measurements are correct.
4.4 You will be provided with any applicable instructions and manuals relating to the products that you order and you will be responsible for making sure that all products, save those installed by us, are applied in accordance with the relevant guidance and standards. If you are in any doubt as to what a product can be used for then please contact us.
4.5 If you request us to reproduce an image or logo on any product, it is your responsibility to ensure that you have obtained permission for such image or logo to be reproduced and you warrant that you have obtained permission to use it or you otherwise own the copyright for such image. We reserve the right to request the permission in writing. We cannot reproduce copyright images without you first having the permission of the copyright owner. By placing an order with us you are confirming that you have the required permission and you agree to indemnify us against all claims and any losses that we may suffer as a result of reproducing any image and/or logo in accordance with your order.

5. OUR RIGHTS TO MAKE CHANGES
5.1 We may change the product:
5.1.1 to reflect changes in relevant laws and regulatory requirements; and
5.1.2 to implement minor technical adjustments and improvements. These changes will not affect your use of the product.
5.2 Every time you order products from us, the terms in force at the time of your order will apply to the contract between you and us. Please look at the top of this page to see when these terms were last updated and which terms were changed.

6. PROVIDING THE PRODUCTS
6.1 The costs of mandatory delivery will be as displayed to you on our website or otherwise notified to you. Collections are also available.
6.2 When we will provide the products.
6.2.1 If the products are goods we, or our courier, will contact you with an estimated delivery date.
6.2.2 We will begin the services on the date agreed with you during the order process. The estimated completion date for the services is as told to you during the order process.
6.3 We are not responsible for delays outside our control. If our supply of the products is delayed by an event outside our control we will contact you to let you know as soon as we are aware and we will take steps to minimise the effect of the delay. Provided we do this we will not be liable for delays caused by the event, but if there is a risk of substantial delay you may contact us to end the contract and receive a refund for any products you have paid for but not received.
6.4 Collection by you. If you have asked to collect the products from our premises, you can collect them from us at a time agreed with us during our working hours of 9am to 5pm on weekdays (excluding public holidays & seasonal closing periods).
6.5 If no one is available at your address to take delivery and the products cannot be posted through your letterbox, left with a neighbour or in your nominated safe place, we will leave you a note informing you of how to rearrange delivery or collect the products from a local depot.
6.6 If you do not collect the products from us as arranged or if, after a failed delivery to you, you do not re-arrange delivery or collect them from a delivery depot we will contact you for further instructions and may charge you for storage costs and any further delivery costs. If, despite our reasonable efforts, we are unable to contact you or re-arrange delivery or collection, if you are a consumer, we may end the contract and clause 11.2 will apply.
6.7 If you do not allow us access to your property to perform the services as arranged (and you do not have a good reason for this) we may charge you additional costs incurred by us as a result. If, despite our reasonable efforts, we are unable to contact you or re-arrange access to your property, if you are a consumer, we may end the contract and clause 11.2 will apply.
6.8 If you are a business and you fail to take delivery of, or collect, the goods within 10 business days of us notifying you they are ready for delivery or collection, we may resell or otherwise dispose of the goods and, after deducting reasonable storage and selling costs, we will account to you for any excess over the price of the goods or charge you for any shortfall below the price of the goods.
6.9 If you are a business and you fail to allow us access to provide the services, we may, without limiting any other rights we have, suspend performance of the services until you allow us access, we will not be liable for any costs or losses sustained or incurred by you arising directly or indirectly from our failure or delay in performing the services and you will reimburse us for any costs or losses sustained arising directly or indirectly from your failure to comply with your obligations.
6.10 A product which is goods will be your responsibility from the time we deliver the product to the address you gave us or you or a carrier organised by you collect it from us.
6.11 You own a product which is goods once we have received payment in full.
6.12 We may need certain information from you so that we can supply the products to you. If so, this will have been stated in the description of the products on our website or given at the time of the order. We will contact you to ask for this information. If you do not give us this information within a reasonable time of us asking for it, or if you give us incomplete or incorrect information, we may either end the contract (and clause 11.2 will apply) or make an additional charge of a reasonable sum to compensate us for any extra work or additional products that are required as a result. We will not be responsible for supplying the products late or not supplying any part of them if this is caused by you not giving us the information we need within a reasonable time of us asking for it.
6.13 We may have to suspend the supply of a product to:
6.13.1 deal with technical problems or make minor technical changes;
6.13.2 update the product to reflect changes in relevant laws and regulatory requirements;
6.13.3 make changes to the product as requested by you or notified by us to you (see clause 5).
6.14 We will contact you in advance to tell you we will be suspending supply of the product, unless the problem is urgent or an emergency. If we have to suspend the product we will adjust the price so that you do not pay for products while they are suspended. You may contact us to end the contract for a product if we suspend it, or tell you we are going to suspend it, in each case for a period of more than 4 weeks and we will refund any sums you have paid in advance for the product in respect of the period after you end the contract.
6.15 In accordance with our privacy policy we may use the information you provide to us to enable us to carry out our obligations arising from this contract and to provide you with the products and we may pass on your contact details and/or order details to our sub-contractors and distributors in order for them to deliver the products to you.

7. PRICE AND PAYMENT
7.1 The price of the product will be the price indicated on the order pages or on your quotation when you placed your order. The prices shown are exclusive of amounts in respect of VAT. You will pay VAT on top of the price listed at the applicable rate. We take all reasonable care to ensure that the price of the product advised to you is correct. However, please see clause 7.3 for what happens if we discover an error in the price of the product you order.
7.2 If the rate of VAT changes between your order date and the date we supply the product, we will adjust the rate of VAT that you pay, unless you have already paid for the product in full before the change in the rate of VAT takes effect.
7.3 It is always possible that, despite our best efforts, some of the products we sell may be incorrectly priced. We regularly check our prices so that, where the product’s correct price at your order date is less than our stated price at your order date, we will charge the lower amount. If the product’s correct price at your order date is higher than the price stated to you, we will contact you for your instructions before we accept your order. If we accept and process your order where a pricing error is obvious and unmistakeable and could reasonably have been recognised by you as a mispricing, we may end the contract, refund you any sums you have paid and require the return of any goods provided to you.
7.4 When you must pay and how you must pay. We accept payment via BACS. For smaller amounts, cheques and most credit cards are also accepted. When you must pay depends on what product you are buying:
7.4.1 Unless otherwise agreed, for goods, you must pay for the products before we dispatch them.
7.4.2 For services, we will invoice you weekly in advance for the services until the services are completed. You must pay each invoice within 30 calendar days after the date of the invoice.
7.5 In some circumstances we may require full or part payment in advance of us beginning work on your Order. If this is the case we will tell you during the order process and payment shall be made on the terms agreed between us in which case clause 7.4 won’t apply.
7.6 If you have a 30 day account with us, we will agree terms of payment with you. You will pay for any goods and services ordered from us within 30 days of the date of invoice and the provisions of clause 7.4 will not apply to you. This clause 7.6 will apply only to those customers with whom we agreed deferred payment terms.
7.7 We can charge interest if you pay late. If you do not make any payment to us by the due date we may charge interest to you on the overdue amount at the rate of 4% a year above the base lending rate of the Bank of England from time to time. This interest shall accrue on a daily basis from the due date until the date of actual payment of the overdue amount, whether before or after judgment. You must pay us interest together with any overdue amount.
7.8 What to do if you think an invoice is wrong. If you think an invoice is wrong please contact us promptly to let us know and we will not charge you interest until we have resolved the issue.
Clauses 8 to 12 (inclusive) apply only if you are a consumer.

8. YOUR RIGHTS TO MAKE CHANGES
If you wish to make a change to the product you have ordered please contact us. We will let you know if the change is possible. If it is possible we will let you know about any changes to the price of the product, the timing of supply or anything else which would be necessary as a result of your requested change and ask you to confirm whether you wish to go ahead with the change. If we cannot make the change or the consequences of making the change are unacceptable to you, you may want to end the contract.

9. YOUR CONSUMER RIGHTS TO END THE CONTRACT
9.1 Ending the contract because of something we have done or are going to do. If you are ending a contract for a reason set out below the contract will end immediately and we will refund you in full for any products which have not been provided and you may also be entitled to compensation. The reasons are:
9.1.1 we have told you about an error in the price or description of the product you have ordered and you do not wish to proceed;
9.1.2 there is a risk that supply of the products may be significantly delayed because of events outside our control;
9.1.3 we have suspended supply of the products for technical reasons, or notify you we are going to suspend them for technical reasons, in each case for a period of more than 4 weeks; or
9.1.4 you have a legal right to end the contract because of something we have done wrong.
9.2 Exercising your right to change your mind (Consumer Contracts Regulations 2013). For most products bought online, via e-mail or by telephone or fax you have a legal right to change your mind within 14 days and receive a refund.
9.3 When you don’t have the right to change your mind. You do not have a right to change your mind in respect of:
9.3.1 services, once these have been completed, even if the cancellation period is still running;
9.3.2 any products which become mixed inseparably with other items after their delivery; and,
9.3.3 any products that are made to your specifications or are clearly personalised.
9.4 How long you have depends on what you have ordered and how it is delivered.
9.4.1 Have you bought services? If so, and you have the legal right to change your mind, you have 14 days after the day we email you to confirm we accept your order. However, once we have completed the services you cannot change your mind, even if the period is still running. If you cancel after we have started the services, you must pay us for the services provided up until the time you tell us that you have changed your mind.
9.4.2 Have you bought goods?, if so, and you have the legal right to change your mind, you have 14 days after the day you (or someone you nominate) receives the goods, unless:
9.4.2.1 Your goods are split into several deliveries over different days. In this case you have until 14 days after the day you (or someone you nominate) receive the last delivery to change your mind about the goods.
9.4.2.2 Your goods are for regular delivery over a set period. In this case you have until 14 days after the day you (or someone you nominate) receive the first delivery of the goods.
9.5 Even if we are not at fault and you do not have a right to change your mind, you can still end the contract before it is completed, but you may have to pay us compensation. A contract for goods is completed when the product is delivered and paid for. A contract for services is completed when we have finished providing the services and you have paid for them. If you want to end a contract before it is completed where we are not at fault and you do not have a right to change your mind, just contact us to let us know. The contract will end immediately and we will refund any sums paid by you for products not provided but we may deduct from that refund (or, if you have not made an advance payment, charge you) reasonable compensation for the net costs we will incur as a result of your ending the contract (including any artwork fee payable).
9.6 For the avoidance of doubt, the provisions set out in this clause 9 do not apply if you are a business customer. Business customers do not have the right to cancel the contract or return the goods just because they have changed their mind.

10. HOW TO END THE CONTRACT WITH US
10.1 To end the contract with us, please let us know by doing one of the following:
10.1.1 Phone or email. Call customer services on 01480 494540 or email us at info@lemark.co.uk . Please provide your name, home address, details of the order (including order number/invoice number) and, where available, your phone number and email address.
10.1.2 By post. Print off the form attached to these terms (see SCHEDULE 1 MODEL CANCELLATION FORM below) and post it to us at the address in clause 2.2. Or simply write to us at that address, including details of what you bought, when you ordered or received it, your order number/invoice number and your name and address.
10.2 Returning products after ending the contract. If you end the contract for any reason after products have been dispatched to you or you have received them, you must return them to us. You must either return the goods in person to where you bought them or allow us to collect them from you. Please call customer services on 01480 494540 or email us at info@lemark.co.uk for a return label or to arrange collection.
10.3 If you end the contract after the products have been shipped, we will pay the costs of return if the products are faulty or misdescribed, if you are ending the contract because we have told you of an upcoming change to the product or these terms, an error in pricing or description, a delay in delivery due to events outside our control or because you have a legal right to do so as a result of something we have done wrong.
10.4 In all other circumstances (including where you are exercising your right to change your mind) you must pay the costs of return. If you are responsible for the costs of return and we are collecting the product from you, we will charge you the direct cost to us of collection.
10.5 We will refund you the price you paid for the products including delivery costs, by the method you used for payment. However, we may make deductions from the price, as described below.
10.6 If you are exercising your right to change your mind:
10.6.1 We may reduce your refund of the price (excluding delivery costs) to reflect any reduction in the value of the goods, if this has been caused by your handling them in a way which would not be permitted in a shop. If we refund you the price paid before we are able to inspect the goods and later discover you have handled them in an unacceptable way, you must pay us an appropriate amount.
10.6.2 The maximum refund for delivery costs will be the costs of delivery by the least expensive delivery method we offer.
10.6.3 Where the product is a service, we may deduct from any refund an amount for the supply of the service for the period for which it was supplied, ending with the time when you told us you had changed your mind. The amount will be in proportion to what has been supplied, in comparison with the full coverage of the contract.
10.7 We will make any refunds due to you as soon as possible. If you are exercising your right to change your mind then:
10.7.1 If the products are goods and we have not offered to collect them, your refund will be made within 14 days from the day on which we receive the product back from you or, if earlier, the day on which you provide us with evidence that you have sent the product back to us.
10.7.2 In all other cases, your refund will be made within 14 days of your telling us you have changed your mind

11. OUR RIGHTS TO END THE CONTRACT
11.1 We may end the contract for a product at any time by writing to you if:
11.1.1 you do not make any payment to us when it is due and you still do not make payment within 10 days of us reminding you that payment is due;
11.1.2 you do not, within a reasonable time of us asking for it, provide us with information that is necessary for us to provide the products, for example, any relevant specification;
11.1.3 you do not, within a reasonable time, allow us to deliver the products to you or collect them from us;
11.1.4 you do not, within a reasonable time, allow us access to your premises to supply the services;
11.1.5 you ask to return products to us in respect of which you have no right to cancel such as made to measure items.
11.2 You must compensate us if you break the contract. If we end the contract in the situations set out in clause 11.1 we will refund any money you have paid in advance for products we have not provided but we may deduct or charge you reasonable compensation for the net costs we will incur as a result of your breaking the contract.

12. IF THERE IS A PROBLEM WITH THE PRODUCT
12.1 If you have any questions or complaints about the product, please contact us. You can telephone our customer service team at 01480 494540 or write to us via email: info@lemark.co.uk or Post: Le Mark Group, Unit 1, Houghton Hill Industries Sawtry Way, Houghton, Huntingdon, Cambridgeshire, PE28 2DH.
12.2 Summary of your legal rights. We are under a legal duty to supply products that are in conformity with this contract. See the box below for a summary of your key legal rights in relation to the product. Nothing in these terms will affect your legal rights.

Summary of your key legal rights

This is a summary of your key legal rights. These are subject to certain exceptions. For detailed information please visit the Citizens Advice website www.adviceguide.org.uk or call 03454 04 05 06.

If your product is goods, the Consumer Rights Act 2015 says goods must be as described, fit for purpose and of satisfactory quality. During the expected lifespan of your product your legal rights entitle you to the following:

  • up to 30 days: if your goods are faulty, then you can get an immediate refund.
  • up to six months: if your goods can’t be repaired or replaced, then you’re entitled to a full refund, in most cases.
  • up to six years: if your goods do not last a reasonable length of time you may be entitled to some money back.

See also Exercising your right to change your mind (Consumer Contracts Regulations 2013).
If your product is services, the Consumer Rights Act 2015 says:

  • you can ask us to repeat or fix a service if it’s not carried out with reasonable care and skill, or get some money back if we can’t fix it.
  • if you haven’t agreed a price beforehand, what you’re asked to pay must be reasonable.
  • if you haven’t agreed a time beforehand, it must be carried out within a reasonable time.

See also Exercising your right to change your mind.

12.3 Your obligation to return rejected products. If you wish to exercise your legal rights to reject products you must either return them in person to where you bought them, or allow us to collect them from you. We will pay the costs of collection. Please call customer services on 01480 494540 or email us at info@lemark.co.uk for a return label or to arrange collection.

13. OUR RESPONSIBILITY FOR LOSS OR DAMAGE SUFFERED BY YOU
13.1 If we fail to comply with these terms, we are responsible for loss or damage you suffer that is a foreseeable result of our breaking this contract or our failing to use reasonable care and skill, but we are not responsible for any loss or damage that is not foreseeable. Loss or damage is foreseeable if either it is obvious that it will happen or if, at the time the contract was made, both we and you knew it might happen, for example, if you discussed it with us during the sales process.
13.2 We do not exclude or limit in any way our liability to you where it would be unlawful to do so. This includes liability for death or personal injury caused by our negligence or the negligence of our employees, agents or subcontractors, for fraud or fraudulent misrepresentation, for breach of your legal rights in relation to the products as summarised at clause 12.1 and for defective products under the Consumer Protection Act 1987
13.3 When we are liable for damage to your property. If we are providing services in your property, we will make good any damage to your property caused by us while doing so. However, we are not responsible for the cost of repairing any pre-existing faults or damage to your property that we discover while providing the services.
13.4 We are not liable for business losses. If you are a consumer we only supply the products for domestic and private use. If you use the products for any commercial, business or re-sale purpose we will have no liability to you for any loss of profit, loss of business, business interruption, or loss of business opportunity.
Clauses 14 to 17 (inclusive) apply only if you are a business customer.

14. IF YOU ARE A BUSINESS CUSTOMER
14.1 If you are not a consumer, you confirm that you have authority to bind any business on whose behalf you use our business or our site to purchase products or services.
14.2 These terms and any document expressly referred to in them constitute the entire agreement between you and us and supersede and extinguish all previous agreements, promises, assurances, warranties, representations and understandings between us, whether written or oral, relating to its subject matter. For the avoidance of doubt, if we have entered into a distribution agreement with you the terms of that agreement shall apply to the exclusion of the terms herein.
14.3 You acknowledge that in entering into the contract with us you do not rely on any statement, representation, assurance or warranty (whether made innocently or negligently) that is not set out in these terms or any document expressly referred to in them.
14.4 You and we agree that neither of us shall have any claim for innocent or negligent misrepresentation or negligent misstatement based on any statement in this contract.

15. TERMINATION
15.1 Without limiting any other rights or remedies we may have, we may terminate the contract with immediate effect by giving notice to you if:-
15.1.1 you commit a material breach of any term of the contract and (if such breach is remediable) fail to remedy that breach within 10 days of being notified to do so; or
15.1.2 you become insolvent or cease to carry on business;
15.1.3 you have failed to pay an amount when due under the contract.
15.2 On termination of the contract for any reason:-
15.2.1 you shall immediately pay all of our outstanding unpaid invoices together with any interest due and we shall submit an invoice for any services or products supplied for which no invoice has yet been submitted and this shall be payable immediately on receipt;
15.2.2 any accrued rights, remedies, obligations and liabilities as at termination shall be unaffected including the right to claim damages in respect of any breach of contract before termination.

16. OUR LIABILITY IF YOU ARE A BUSINESS
16.1 We only supply products for internal use by your business, and you agree not to use the products for any resale purposes unless we have otherwise agreed terms of a distribution agreement with you.
16.2 Nothing in these terms limits or excludes our liability for death or personal injury caused by our negligence, fraud or fraudulent misrepresentation, breach of the terms implied by section 12 of the Sale of Goods Act 1979 (title and quiet possession) or defective products under the Consumer Protection Act 1987.
16.3 Subject to clause 16.2, we will under no circumstances whatever be liable to you, whether in contract, tort (including negligence), breach of statutory duty, or otherwise, arising under or in connection with the Contract for any loss of profits, sales, business, or revenue, loss or corruption of data, information or software, loss of business opportunity, loss of anticipated savings, loss of goodwill or any indirect or consequential loss.
16.4 Subject to clause 16.2, our total liability to you in respect of all losses arising under or in connection with the contract between us shall in no circumstances exceed the price of the products and/or services you have ordered.
16.5 Except as expressly stated in these terms, we do not give any representation, warranties or undertakings in relation to the products or services we provide. Any representation, condition or warranty which might be implied or incorporated into these terms by statute, common law or otherwise is excluded to the fullest extent permitted by law. In particular, we will not be responsible for ensuring that the products are suitable for your purposes.

17. COMMUNICATIONS BETWEEN US IF YOU ARE A BUSINESS CUSTOMER
17.1 Any notice or other communication given by you to us, or by us to you, under or in connection with the contract between us shall be in writing and shall be delivered personally, sent by pre-paid first class post or other next working day delivery service or e-mail.
17.2 A notice or other communication shall be deemed to have been received: if delivered personally, when left at our registered office; if sent by pre-paid first class post or other next working day delivery service, at 9.00 am on the second Business Day after posting or if sent by e-mail, one Business Day after transmission.
17.3 In proving the service of any notice, it will be sufficient to prove, in the case of a letter, that such letter was properly addressed, stamped and placed in the post and, in the case of an e-mail, that such e-mail was sent to the specified e-mail address of the addressee.
17.4 The provisions of this clause shall not apply to the service of any proceedings or other documents in any legal action.
The following clause 18 applies to all customers.

18. OTHER IMPORTANT TERMS
18.1 We may transfer our rights and obligations under these terms to another organisation.
18.2 You may only transfer your rights or your obligations under these terms to another person if we agree to this in writing.
18.3 This contract is between you and us. No other person shall have any rights to enforce any of its terms.
18.4 Each of the paragraphs of these terms operates separately. If any court or relevant authority decides that any of them are unlawful, the remaining paragraphs will remain in full force and effect.
18.5 If we do not insist immediately that you do anything you are required to do under these terms, or if we delay in taking steps against you in respect of your breaking this contract, that will not mean that you do not have to do those things and it will not prevent us taking steps against you at a later date.
18.5.1 If you are a consumer. These terms are governed by English law and you can bring legal proceedings in respect of the products in the English courts. If you live in Scotland you can bring legal proceedings in respect of the products in either the Scottish or the English courts. If you live in Northern Ireland you can bring legal proceedings in respect of the products in either the Northern Irish or the English courts.
18.6 If you are a business, a contract and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims) shall be governed by and construed in accordance with the law of England and Wales and we both irrevocably agree that the courts of England and Wales shall have exclusive jurisdiction to settle any dispute or claim arising out of or in connection with a contract or its subject matter or formation (including non-contractual disputes or claims).

SCHEDULE 1
MODEL CANCELLATION FORM

(Complete and return this form only if you wish to withdraw from the contract)

To: Le Mark Group, Unit 1, Houghton Hill Industries Sawtry Way, Houghton, Huntingdon, Cambridgeshire, PE28 2DH. Tel: 01480 494540 Email: info@lemark.co.uk

I/We [*] hereby give notice that I/We [*] cancel my/our [*] contract of sale of the following goods [*]/for the supply of the following service [*],

Ordered on [*]/received on [*],

Name of consumer(s),

Address of consumer(s),

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

Date
[*] Delete as appropriate
© Crown copyright 2013.