1. THESE TERMS
1.1 What these terms cover. These are the terms and conditions on which we supply our services or products to you, whether these are services (such as booking your driving theory test) or digital content (such as providing our online practice theory tests or e-books).
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 our services and 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 Important clauses. We would request that you read all of these terms and conditions carefully so that you understand your rights and obligations under a contract. However, we would draw your attention in particular to clause 3.3 (free retests and how to qualify for a free retest), clause 3.4 (failure to attend and how to make changes to your booking), clause 5 (your right to make changes), clause 9.4 (when you don’t have the right to change your mind), clause 9.5.2 (changing your mind – digital content), clause 9 (your rights to end the contract), clause 10.3 (deductions from refunds if you exercise your right to change your mind), clause 11 (our rights to end the contract) and clause 14 (our responsibility for loss or damage suffered by you).
1.4 “Working day”. Where we refer to a working day in these terms, this means any day that is not a Saturday or Sunday or a public bank holiday in England.
2. INFORMATION ABOUT US AND HOW YOU CAN CONTACT US
2.1 Who we are. We are GEXT Limited (trading as The Theory Test), a company registered in England and Wales. Our company registration number is 09216405 and our registered office is at 83 Ducie Street, Manchester, M1 2JQ. Our VAT number is GB310209463.
2.2 How to contact us. You can contact us by email or in writing by post at firstname.lastname@example.org or 83 Ducie Street, Manchester, M1 2JQ.
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 “Writing” includes emails. When we use the words “writing” or “written” in these terms, this includes emails.
3. OUR SERVICES
3.1 Our services and products. We provide an online facility via our website (www.studytheory.co.uk) which allows you to book your driving theory test online. We also provide online practice theory tests and e-books (including the Highway Code e-book and traffic signs e-book) to you, including via our website, for you to complete before sitting your actual driving theory test (see clause 3.2).
3.2 Our digital content. To help you prepare for your driving theory test (and any resits you may take), we provide digital content in the form of practice theory tests on our website and e-books. The practice tests we provide are for illustrative purposes only and are designed to contain examples of the types of questions that you may be asked in your actual test. Unfortunately, our practice tests do not cover the hazard perception element of a theory test. The e-books that we provide may be subject to change as regulations and driving rules change.
3.3 PASS GUARANTEE AND HOW TO QUALIFY FOR A FREE RETEST. Where you sit your driving theory test on your allocated date and fail the test, you will only be eligible for a free retest (and any subsequent free retests) if you satisfy the terms of this clause (as set out to you when you submitted your order online). These terms must be satisfied by you to be eligible for each retest you need to take. As our services do not include hazard perception tests, you will not be eligible for a free retest if you fail that element of your theory test. To qualify for each free retest the following conditions must apply:-
3.3.1 you have booked your driving theory test online via our website;
3.3.2 prior to sitting (and resitting) each driving theory test, you successfully passed a minimum of 10 practice tests on our website;
3.3.3 you turned up to your driving theory test booking on your allocated date and time and sat and failed the test (and didn’t miss the appointment); and
3.3.4 you failed the theory element of the driving theory test, and not the hazard perception element of the test.
3.3.5 Email email@example.com with evidence proving the failed theory test for review.
3.4 FAILURE TO ATTEND BOOKED TEST AND HOW TO MAKE CHANGES TO YOUR BOOKING. Unfortunately we cannot provide a free retest where you have failed to attend your driving theory test booking. It is important that you let us know if you cannot attend your booked driving theory test or that you want to rearrange it as soon as possible and we will try to reschedule it on your behalf and let you know if this is possible (please see clause 5 for more details). If you miss your appointment without letting us know, or on short notice (see clause 5 for what “short notice” means), then you will not be eligible for a free retest and will have to pay in full for the retest.
3.5 You can also amend your booking yourself by using the government driving theory test website, the details of which will be contained in your driving theory test booking confirmation (although you should note that restrictions will also apply in relation to cancelling or amending your booking on short notice and we would recommend that you familiarise yourself with any restrictions on the government driving theory test website when you have received your driving theory test booking confirmation).
3.6 Unavailable Dates & Times. If the selected time & date of your test becomes unavailable you will be informed and placed on our priority list to automatically reschedule your booking for the next available slot at the same test centre. We are not responsible for issues relating to unavailable dates and cancellations that occur due to covid delays, restrictions and other 3rd party issues outside of our control.
3.7 Incorrect customer details. Please ensure the details you have provided are correct as we are not held responsible for issues relating to incorrect details entered by you (the customer) that may affect your booking. This agreement provides confirmation that you are responsible and no refund shall be provided for issues related to this.
4. OUR CONTRACT WITH YOU
4.1 Submitting your order online. By submitting the online order form to book your driving theory test and to access our online practice tests, you are making an offer to us to purchase these services and products in accordance with these terms. If you are under the age of 18 any order must either be made on your behalf by a parent or legal guardian or under the supervision of a parent or legal guardian.
4.2 How we will accept your order. 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.
4.3 If we cannot accept your order. If we are unable to accept your order, we will inform you of this and will not charge you. This could be for a number of reasons including (for example) that we have identified an error in the price or description of the product, because the product is no longer available or because we are no longer offering theory tests at your preferred theory test centre or an appointment is no longer available on your preferred theory test date. We will try our best to suggest suitable alternatives for you where possible.
4.4 Your order number. We will assign an order number to your order and tell you what it is when we accept your order. It will help us if you can tell us the order number whenever you contact us about your order.
4.5 We only sell to the UK. Our website is solely for the promotion of our products in the UK and for customers with a valid provisional UK driving licence and number. Unfortunately, we do not accept orders from outside the UK.
5. YOUR RIGHTS TO MAKE CHANGES
If you wish to make a change to the date, time or driving centre for your booked driving theory test, please contact us as soon as possible before your appointment. We will let you know if the change is possible and if there are any additional costs. In order to amend, rearrange or cancel your booking, you will need to provide at least 3 clear full working days’ notice of the date of your booked driving theory test. For example, if your booking is on a Friday, you will need to provide us with notice of cancellation or rearrangement on the Monday (unless this is a public holiday, in which case on the previous working day). Although we will do our best to make any changes, we cannot guarantee that you will be able to change your appointment once it is booked as this is booked through a third party and will be subject to their terms.
6. OUR RIGHTS TO MAKE CHANGES
6.1 Minor changes to the products. We may change the product:
6.1.1 to reflect changes in relevant laws and regulatory requirements for example to make sure that any digital content is up-to-date with the current driving rules, regulations or requirements or to make sure that the practice tests contains the types of questions that may be asked in your actual test; and
6.1.2 to implement minor technical adjustments and improvements, for example to address a security threat. These changes will not affect your use of the product.
6.2 More significant changes to the products and these terms. In addition, as we informed you when you submitted your online order form, in rare circumstances we may need to make changes to the time or date of your booked driving theory test, or the venue. If we do need to make changes to your booked test, we will give you as much notice as possible and provide you with alternative options where possible. If you are unhappy with the changes, you may contact us to end the contract before the changes take effect and receive a refund for your booking.
6.3 Updates to digital content. We may update or require you to update digital content, provided that the digital content shall always match the description of it that we provided to you before you bought it.
7. PROVIDING THE PRODUCTS
7.1 When we will provide the products.
7.1.1 Driving Theory Test. We will arrange the booking of your driving theory test shortly after we accept your order, which will be arranged to take place on the date and time agreed with you.
7.1.2 Practice Driving Theory Tests and other digital content. We will make the practice theory tests and e-books available for access by you as soon as we accept your order.
7.2 We are not responsible for delays outside our control. If your booked test is delayed or cancelled by an event outside of our control (for example if the test centre cannot fulfil the booking) or if you cannot access the practice tests for a reason outside of our control (for example if there is an internet shortage or an issue that due to a fault with the internet of that nature), then we will contact you as soon as possible to let you know 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. Alternatively, where possible, you can rearrange your test booking and we will help you with alternative options.
7.3 What will happen if you do not give required information to us. We may need certain information from you so that we can supply the products to you, for example, accurate information which is required to book your driving theory test (including information contained on your provisional driving licence). This information is contained in our online form, however we will contact you in writing to ask for any further information we may require to complete your booking. 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 that is required as a result. We will not be responsible for you missing your booking, or being unable to sit your test, if this is caused by you not giving us the information we need within a reasonable time of us asking for it.
7.4 Reasons we may suspend the supply of products to you. We may have to suspend the supply of a product (such as our practice tests) to:
7.4.1 deal with technical problems or make minor technical changes; or
7.4.2 update the product to reflect changes in relevant laws and regulatory requirements; or
7.5 Suspending the product to carry out maintenance. There may be occasions when we have to suspend the supply of a product (for example our practice tests) or temporarily suspend access to our website to carry out maintenance work (for example where there are technical problems). 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. Where we do have to carry out non-urgent maintenance, we will carry out the maintenance during specific hours which are communicated to you in advance (for example between 10pm and 2am).
7.6 Your rights if we suspend the supply of products. If we have to suspend the product, for example the practice tests, for longer than 72 hours in any 30 day period 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 72 hours and we will refund any sums you have paid in advance for the product in respect of the period after you end the contract.
7.7 We may also suspend or withhold supply of the products if you do not pay or if there is a problem with payment. If you do not pay us for the products when you are supposed to (see clause 13.4) or if there is an issue with payment and you still do not make payment within 7 days of us reminding you that payment is due, we may suspend or withhold the supply of any products until you have paid us the outstanding amounts. We will contact you to tell you we are suspending or withholding supply of the products. We will not charge you for the products during the period for which they are suspended.
8. ATTENDING THE TEST CENTRE FOR YOUR DRIVING THEORY TEST
8.1 You must attend the test centre at the time and date that your driving theory test has been booked (in accordance with the details contained in our confirmation email of your booking).
8.2 When you attend the test centre for your booked theory test, you must take with you:
8.2.1 a valid signed UK photocard driving licence and the paper counterpart to be presented at the test centre; or
8.2.2 if you do not have a photocard licence, your old style valid signed UK paper driving licence and a valid UK passport;
and any other information or documentation that we make you aware of in advance of your driving theory test.
9. YOUR RIGHTS TO END THE CONTRACT
9.1 You may be able to end your contract with us in different ways. Where you are able to end the contract, your rights when you end the contract will depend on what you have bought, whether there is anything wrong with it, how we are performing and when you decide to end the contract:
9.1.1 If what you have bought is faulty or misdescribed you may have a legal right to end the contract (or to get a product repaired or replaced or a service re-performed or to get some or all of your money back), see clause 12;
9.1.2 If you want to end the contract because of something we have done or have told you we are going to do, see clause 9.2;
9.1.3 If you have just changed your mind about the product, see clause 9.3. You may be able to get a refund if you are within the cooling-off period, but this may be subject to deductions;
9.1.4 In all other cases (if we are not at fault and there is no right to change your mind), see clause 9.6.
9.2 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 at 9.2.1 to 9.2.5 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:
9.2.1 we have told you about an upcoming change to the product or these terms which you do not agree to (see clause 6.2);
9.2.2 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 (see clause 13.3);
9.2.3 there is a risk that supply of the products may be significantly delayed because of events outside our control (for example, the test centre near you is no longer providing driving theory tests or the test centre cannot accommodate bookings at that time);
9.2.4 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 72 hours; or
9.3 Exercising your right to change your mind (Consumer Contracts Regulations 2013). For most products bought online you have a legal right to change your mind within 14 days however our digital content cannot be returned once it has been downloaded or streamed via for example email, online account or website therefore you waive your right to cancel and the 14 day cooling off period is waived. These rights, under the Consumer Contracts Regulations 2013, are explained in more detail in these terms.
9.4 You do not have a right to change your mind where:
9.4.1 you have accessed or started to use our online practice tests or digital content, or where we have provided our digital content to you immediately and you agreed to us doing this during the order process (see clause 9.5.2); or
9.4.2 you have booked a driving theory test which is due to take place during the 14 day cancellation period and you attend and sit that test.
9.5 How long do I have to change my mind? How long you have depends on what you have ordered and how it is delivered.
9.5.1 Have you booked a driving theory test? If so, you have 14 days after the day we email you to confirm we accept your order to change your mind. However, once we have started to provide the services (for example, where we take steps to book your test with the DVSA) and you cancel the contract, you must pay us for the services provided up until the time you tell us that you have changed your mind. If you have booked your driving theory test to take place during the 14 day cancellation period, in order to get a refund of the proportion of the price of the booked driving theory test (i.e. the amount of our price that is dedicated to the booked driving theory test) you will need to cancel the contract within 3 clear working days of the date of your booked test (for example if your booking is to take place on a Friday, you will need to cancel the contract with us on the Monday (unless the Monday is a public holiday in which case the previous working day)). This is because we will be unable to obtain a refund of the price of the booked test from the DVSA if we provide short notice to them. For information on the practice tests and digital content see clause 9.5.2.
9.5.2 Our practice tests and digital content. You have 14 days to change your mind after the day we email you to accept your order, or, if earlier, until you start using or streaming our practice tests. However, if we delivered the digital content to you immediately or made the practice tests available to you immediately (for example by email), and you agreed to this when ordering, you will not have a right to change your mind.
9.6 Ending the contract where we are not at fault and there is no right to change your mind. Even if we are not at fault and you do not have a right to change your mind (see clause 9.1), you can still end the contract before it is completed, but you may have to pay us compensation. A contract for digital content (including our e-books and practice tests) is completed when the product is delivered, downloaded or streamed and paid for (so, where we have delivered digital content to you, this part of the contract will be completed and you will not be able to end it and obtain a refund). 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 have not changed your mind, just contact us to let us know. Where you do end the contract or part of the contract, it will end immediately and we will refund any sums paid by you for products or services 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 the cost paid for booking your driving theory test if we cannot recover this from the DVSA (such as if you are wanting to end the contract within short notice of your booked driving theory test – see clause 5) and a reasonable sum for our costs for work carried out.
9.7 Refund Policy. studytheory.co.uk also has a discretionary Refund Policy. You hereby acknowledge and agree that, despite reference to a refund policy, that studytheory.co.uk has a standard no-refund policy. Like most website businesses, we do not grant refunds because the economic cost of opening, establishing, processing and maintaining a customer’s account, practice material as well as incurring other 3rd party costs. Therefore, we issue refunds only in rare, meritorious cases, in our sole and exclusive discretion. We issue a refund for qualifying customers of the Pass Guarantee Programme at which only the cost of the booking (£23) is refunded.
10. HOW TO END THE CONTRACT WITH US (INCLUDING IF YOU HAVE CHANGED YOUR MIND)
10.1 Tell us you want to end the contract. To end the contract with us, please let us know by doing one of the following:
10.1.1 Email. Email us at firstname.lastname@example.org. Please provide your name, home address, details of the order and, where available, your phone number and email address.
10.2 How we will refund you. We will refund you the price you paid for the products, by the method you used for payment. However, we may make deductions from the price, as described below.
10.3 Deductions from refunds if you are exercising your right to change your mind. If you are exercising your right to change your mind:
10.3.1 Where we have agreed to book your test for you, we may deduct from any refund an amount for the steps we have completed towards arranging your driving theory test. The amount will be in proportion to what we have supplied, in comparison with the full coverage of the contract, for example we may deduct costs for our time to arrange your booking.
10.3.2 Where you change your mind and your driving theory test is due to take place within 3 working days, we will deduct the costs of the booking from any refund. As we book your test though the DVSA our ability to cancel tests is subject to their terms and conditions. We can only get a refund from the DVSA when cancelling or rearranging your test booking if it is cancelled or rearranged within 3 clear working days of the date of your test. For example if your test is due to take place on a Friday, the latest we can cancel and obtain a refund for the test is the Monday before (unless this is a public holiday in which case the previous working day). If you change your mind within 3 working days of your test, then we will not be able to refund you for the cost of the booking (or rearrange the booking). This is because we will be unable to obtain a refund of the price of the booked test from the DVSA if we provide short notice to them
10.3.3 Where we have delivered digital content to you immediately in accordance with clause 9.5.2, any refund to you will not include the proportion of the price for the digital content that you have been provided with.
10.4 When your refund will be made. We will make any refunds due to you as soon as possible. If you are exercising your right to change your mind then 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 if you break it. 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 or there is a problem with payment and you still do not make payment within 7 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 information that we need from you to complete your booking or to confirm your identity.
11.1.3 you use our website or the products in any unauthorised way, for example by doing any of following (except as may be allowed by any applicable law):
(a) attempt to copy, modify, duplicate, create derivative works from, frame, mirror, republish, download, display, transmit or distribution all or any portion of the services or the materials on the site in any form or media or by any means; or
(b) attempt to reverse compile, disassemble, reverse engineer or otherwise reduce our products to human-perceivable form all or any part of the services; or
(c) access all or any part of the services in order to build a product or service which competes with the services; or
(d) use the services to provide services to third parties; or
(e) license, sell, rent, lease, transfer, assign, distribute, display, disclose, or otherwise commercially exploit, or otherwise make the services available to a third party; or
(f) attempt to obtain, or assist, any third party in obtaining access to the services.
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 the amount paid by us to book your driving theory test where we cannot cancel your booked appointment and any other net costs we will incur as a result of you breaking the contract.
11.3 We may withdraw the product. We may write to you to let you know that we are going to stop providing the product. We will let you know at least 7 days in advance of our stopping the supply of the product and will refund any sums you have paid in advance for products which will not be provided.
12. IF THERE IS A PROBLEM WITH THE PRODUCT OR OUR WEBSITE
12.1 How to tell us about problems. If you have any questions or complaints about the product or our website, please contact us. You can contact our customer service team by writing to us at email@example.com or 83 Ducie Street, Manchester, M1 2JQ.
13. PRICE AND PAYMENT
13.1 Where to find the price for the product. The price of the product (which includes VAT) will be the price indicated on the order pages when you placed your order. We take all reasonable care to ensure that the price of the product advised to you is correct. However, please see clause 13.3 for what happens if we discover an error in the price of the product you order.
13.2 We will pass on changes in the rate of VAT. 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.
13.3 What happens if we got the price wrong. It is always possible that, despite our best efforts, some of the products we sell may be incorrectly priced. We will normally check prices before accepting your order 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.
13.4 When you must pay and how you must pay. We accept payment by all major credit and debit cards. You must pay for the products at the time of submitting your order for a driving theory test appointment. We will not be able to confirm your booking with us until the price has been paid in full for the products.
14. OUR RESPONSIBILITY FOR LOSS OR DAMAGE SUFFERED BY YOU
14.1 We are responsible to you for foreseeable loss and damage caused by us. 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.
14.2 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 including the right to receive products which are: as described and match information we provided to you; of satisfactory quality; fit for any particular purpose made known to us; supplied with reasonable skill and care and, where installed by us, correctly installed.
14.3 We will not be responsible to you for failures to digital content that are outside of our control. We will not responsible for any delays, delivery failures, or any other loss or damage resulting from the nature of the internet or the transfer of data over communications networks and facilities, where this is outside of our control. Unfortunately, given the nature of the internet, some of our services (including the online practice theory tests or the ability to make contact with us online) may be subject to limitations, delays and other problems inherent in the use of the internet and/or communication networks.
14.4 When we are liable for damage to your property. If defective digital content which we have supplied damages a device or digital content belonging to you and this is caused by our failure to use reasonable care and skill we will either repair the damage or pay you compensation. However, we will not be liable for damage which you could have avoided by following our advice to apply an update offered to you free of charge or for damage which was caused by you failing to have in place any minimum system requirements advised to you in advance.
14.5 We are not liable for business losses. 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.
15. HOW WE MAY USE YOUR PERSONAL INFORMATION
16. OTHER IMPORTANT TERMS
16.1 We may transfer this Agreement to someone else. We may transfer our rights and obligations under these terms to another organisation. We will contact you to let you know if we plan to do this. If you are unhappy with the transfer you may contact us to end the contract within 7 days of us telling you about it and we will refund you any payments you have made in advance for products not provided.
16.2 You need our consent to transfer your rights to someone else. You may only transfer your rights or your obligations under these terms to another person if we agree to this in writing. We may not agree if (for example) the booking for the driving theory test has been confirmed by the centre and they cannot action the transfer or if you have already accessed our practice theory tests on our website.
16.3 Nobody else has any rights under this contract (except someone you pass your guarantee on to). This contract is between you and us. No other person shall have any rights to enforce any of its terms.
16.4 If a court finds part of this contract illegal, the rest will continue in force. 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.
16.5 Even if we delay in enforcing this contract, we can still enforce it later. 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. For example, if you miss a payment and we do not chase you but we continue to provide the products, we can still require you to make the payment at a later date.
16.6 Which laws apply to this contract and where you may bring legal proceedings. 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.
Model Cancellation Form
(Complete and return this form only if you wish to withdraw from the contract)
To Gext Limited
83 Ducie Street,
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),
[*] Delete as appropriate