Skyroam GmbH. Terms of Service (Purchase)

Last Updated: July 18th, 2017

Thanks for using Skyroam!

These terms of service and (“T&Cs,” “Agreement,”) cover your use and access to Skyroam’s wireless modem hotspot, products, accessories, services, and websites (“Products and Services” or (if in physical form) “Equipment”). This is a contract between you and Skyroam GmbH, having its registered office at c/o WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, Germany ("Skyroam"). By using the Products and Services and agreeing to these T&C’s, you're agreeing to be bound by these T&Cs and Skyroam’s Privacy Policy. If you're using Skyroam’s Products and Services for an organization, you're agreeing to these T&Cs on behalf of that organization.

For contracts other than the purchase of Equipment, our separate Skyroam GmbH Terms of Service (Rental) apply.

BEFORE YOU USE THE PRODUCTS AND SERVICES, PLEASE CAREFULLY READ THESE TERMS AND CONDITIONS SET FORTH HEREUNDER. BY USING THE PRODUCTS AND SERVICES AND AGREEING TO THESE T&Cs, YOU ARE BOUND BY AND HAVE BECOME A PARTY TO THIS AGREEMENT. IF YOU DO NOT AGREE TO BE BOUND BY THIS AGREEMENT, THEN PLEASE DO NOT CONTINUE TO USE THE PRODUCTS AND SERVICES. SKYROAM RESERVES THE RIGHT TO AMEND THESE T&Cs AT ANY TIME. YOUR CONTINUED ACCESS OR USE OF THE PRODUCTS AND SERVICES WILL CONSTITUTE ACCEPTANCE OF THE MODIFIED T&CS. SKYROAM RESERVES THE RIGHT TO REFUSE PERODUCTS AND SERVICES TO ANYONE FOR ANY REASON AT ANY TIME.

THIS AGREEMENT MAY ONLY BE SUPERSEDED BY A SEPARATE AGREEMENT WITH SKYROAM, INC. THAT EXPRESSLY REFERENCES AND SUPERSEDES THIS AGREEMENT (A “SUPERSEDING AGREEMENT”).

If you purchased your Product and Services from a reseller or partner who is authorized by Skyroam to sell such Equipment (“Authorized Partner”), these T&Cs will still apply as the Agreement between Skyroam and you for your applicable use.

PURCHASE TERMS: Section 1: Products & Services

In addition to the Products and Services, Skyroam also provides a quick start guide to travelers who plan to visit the United Kingdom, Europe, Asia, or other international destinations covered by Skyroam as listed on the Skyroam website.

SERVICE POLICY: While data consumption is unlimited, in select cases your service speed may be reduced after 500MB of daily usage. Most customers receive over 1GB full speed data

Section 2: Eligibility to Purchase

While the Products and Services may be used by travelers of any age, Skyroam will only allow purchases from adults who are at least 18 years of age. If you are not 18 years of age, you represent that you are at least the age of majority in your respective state or province of residence; or that you are the age of majority in your state or province of residence and you have given Skyroam your consent to allow your minor dependents to use the Products and Services.

Section 3: Delivery

When you place an order to purchase, Skyroam asks that you inspect all Equipment upon receipt and to verify that it is in good working order and condition. It is your responsibility to ensure that you are available to receive and that you accept the delivery of the Equipment. Skyroam will assume all risk of loss and damage from the delivery of the Equipment from the point of sale to your designated address.

Section 4: Use of Equipment

You agree to exercise reasonable care in the use of all Products and Services, and to handle all Equipment in accordance with these T&Cs and quick start guide.

You further agree that in the event you do any of the following, our liability towards you may be limited: if you

(a) make repairs or modifications, or alter in any way, the Equipment (including but not limited to the swapping of a non-authorized Equipment battery);

(b) share the Equipment with any third party, or allow any such third party to use the Equipment, with the sole exception of a family member, companion, or friend on your trip (up to five devices);

(c) use the Equipment for any illegal purpose, including in violation of your jurisdiction (including but not limited to copyright laws).

(d) use the Products and Services or its content:

(i) for any unlawful purpose; (ii) to solicit others to perform or participate in any unlawful acts; (iii) to violate any international, federal, provincial or state regulations, rules, laws, or local ordinances; (iv) to infringe upon or violate Skyroam’s intellectual property rights or the intellectual property rights of others; (v) to harass, abuse, insult, harm, defame, slander, disparage, intimidate, or discriminate based on gender, sexual orientation, religion, ethnicity, race, age, national origin, or disability; (vi) to submit false or misleading information; (vii) to upload or transmit viruses or any other type of malicious code that will or may be used in any way that will affect the functionality or operation of the Services or of any related Skyroam website, other websites, or the internet; (viii) to collect or track the personal information of others; (ix) to spam, phish, pharm, pretext, spider, crawl, or scrape; (x) for any obscene or immoral purpose; or (xi) to interfere with or circumvent the security features of the Services or any related Skyroam website, other websites, or the internet.

(e) use the Equipment to transmit worms or viruses or any code of a destructive nature.

Skyroam reserves the right to terminate your use of the Services for violating any of these prohibited uses in Section 4, subject to unsuccessful expiry of a reasonable cure period set by Skyroam, or an unsuccessful prior warning, as the case may be and if so required under applicable law.

Section 5. Your Right of Withdrawal

If you order Equipment from our Site as a consumer within the meaning of § 13 of the German Civil Code, you are entitled to a right of withdrawal in accordance with the following provisions.

Information about your Right of Withdrawal

Right of Withdrawal

You have the right to withdraw from this contract within 14 days without giving any reason.

The withdrawal period will expire after 14 days from the day on which you acquire, or a third party other than the carrier and indicated by you acquires, physical possession of the last good.

To exercise the right of withdrawal, you must inform us (Skyroam GmbH, c/o WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, support_eu@skyroam.com, (+49) 30 726 11 894 of your decision to withdraw from this contract by an unequivocal statement (e.g. a letter sent by post, fax or e-mail). You may use the attached model withdrawal form, but it is not obligatory.

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

Effects of Withdrawal

If you withdraw from this contract, we shall reimburse to you all payments received from you, including the costs of delivery (with the exception of the supplementary costs resulting from your choice of a type of delivery other than the least expensive type of standard delivery offered by us), without undue delay and in any event not later than 14 days from the day on which we are informed about your decision to withdraw from this contract. We will carry out such 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 such reimbursement.

We may withhold reimbursement until we have received the goods back or you have supplied evidence of having sent back the goods, whichever is the earliest.

You shall send back the goods or hand them over to us, without undue delay and in any event not later than 14 days from the day on which you communicate your withdrawal from this contract to us. The deadline is met if you send back the goods before the period of 14 days has expired.

You will have to bear the direct cost of returning the goods.

You are only liable for any diminished value of the goods resulting from the handling other than what is necessary to establish the nature, characteristics and functioning of the goods.

Section 6: Fees & Charges

(a) Purchase Charges. The use of purchased Equipment is assessed using 24 hour day passes (“daypasses”) for up to five devices, commencing as of the rental start date when you click start and confirm on your Skyroam hotspot screen. Daypasses may be purchased at our designated store: a.Skyroam.com, our Skyroam Consumer Portal. Current fees for daypasses and the Equipment are posted on our website and may be amended without prior notice (however without retroactive effect). If you have a remaining balance of two daypasses or less, they will expire after 12 months of inactivity. If you have a balance of daypasses in your account and you do not use the balance of daypasses in that account for 12 continuous months, two daypasses will expire from your account at that time and again every 12 months. Using a least one daypass resets the 12 month cycle of inactivity. If after twelve months of non-use there is only a balance of one daypass, then one daypass will expire. If no balance remains, no daypasses will expire. Please note that Skyroam does not apply any credit for a partial billing date; all partial days will be treated as full days for billing purposes.

To place any purchase order on our Equipment, you may purchase on our online store, as hosted by Shopify. Skyroam requires a credit card or PayPal account for all charges. The credit card or PayPal account details will be kept on file in the event that other Service Charges need to be placed. Purchases may also be made, including but not limited to, on Amazon.com, Lazada.com, eBay and other marketplaces, which will be governed by the respective T&Cs of each marketplace.

(b) Service Charges. Usage charges must be pre-paid according to the current airtime and data rate schedule for daypasses, as posted on Skyroam’s website. In some cases, charges from enterprises may be post-paid if agreed in a signed writing in advance by both Skyroam and the enterprise.

(c) Cancellation. You can cancel your account or use of daypasses anytime you want, there is no cancellation fee. If your Equipment has already been dispatched, then Skyroam will not be able to refund relevant shipping charges. If you already have received the Equipment and wish to cancel, you will need to return it to Skyroam immediately. Upon cancelation of your account, you will forfeit all daypasses in the account. No refund for unused daypasses is allowed.

(d) Duty / Tax Charges / VAT. Depending on the country of where your purchase transaction is taking place, you may be subject to Duty / Tax / VAT Charges in which case you will be responsible for these charges. We will however show all prices including applicable VAT in sales to consumers or if otherwise required under applicable law.

Section 7: Ownership of Equipment

By purchasing the Equipment or Skyroam hotspot, you will obtain property rights as to the specific Equipment for your personal use, but you will have no right to act as re-seller or distributor for Skyroam.

Section 8: Skyroam’s Warranty

One (1) Year Warranty (“Gewährleistung”). If you are a business customer or a legal person, Skyroam will exchange or repair any units or parts that are defective within one-year of when you purchased your Equipment. Please contact support_eu@skyroam.com so Skyroam may assess any Product or Equipment issues to help resolve. It is your obligation to notify Skyroam immediately in the event that you experience any problem with your Equipment. In case the law in the locale in which the Skyroam hotspot was purchased by an authorized Skyroam dealer required a warranty longer than one year, the warranty shall equal the minimum required by law.

If you are a consumer, your statutory warranty claims will apply.

Section 9: Disclaimer of Warranties

SUBJECT TO SECTION [10A] HEREAFTER WHICH PREVAILS IF YOU RESIDE IN GERMANY: EXCEPT FOR THE [QUALITY PROMISE] WARRANTY SET FORTH IN SECTION 8 ABOVE, SKYROAM MAKES NO REPRESENTATIONS, WARRANTIES, CONDITIONS, OR GUARANTIES, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE, ORAL OR WRITTEN, REGARDING THE EQUIPMENT OR THIS AGREEMENT. SKYROAM CANNOT WARRANT ITS PRODUCTS AND SERVICES WILL OPERATE UNINTERRUPTED OR ERROR-FREE, THAT IT WILL OPERATE PROPERLY ON ALL WIRELESS NETWORKS, THAT IT WILL MEET ALL OF YOUR NEEDS, OR THAT ANY THAT YOU ACCESS WILL BE UNINTERRUPTED, ERROR-FREE, OR MEET YOUR NEEDS. SKYROAM CANNOT BE RESPONSIBLE FOR THE LEGALITY, ADEQUACY, ACCURACY, QUALITY, OR OPERATION OF ANY THIRD PARTY PRODUCTS OR SERVICES. SKYROAM EXPRESSLY DISCLAIMS ALL OTHER WARRANTIES WITH RESPECT TO THE PRODCUTS AND SERVICES, AND ANY THIRD PARTY PRODUCTS OR SERVICES ACCESSED THROUGH ITS PRODUCTS AND SERVICES, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NON-INFRINGEMENT OF THIRD PARTY RIGHTS. YOU ASSUME SOLE AND EXCLUSIVE RESPONSIBILITY FOR THE USE OF THE EQUIPMENT AND FOR ANY RELIANCE ON ANY THIRD PARTY PRODUCTS OR SERVICES.

While Skyroam will make every effort to erase all personal information left on returned Equipment, YOU ASSUME THE SOLE RISK AND RESPONSIBILITY FOR ERASING PERSONAL INFORMATION PRIOR TO RETURNING EQUIPMENT RENTED PURSUANT TO THIS T&CS AS THE EQUIPMENT IS NOT INTENDED FOR ANY STORAGE OR USE, INCLUDING BUT NOT LIMITED TO STORING PERSONAL INFORMATION AND DATA.

Section 10: Consequential Damages; Limitation of Liability

SUBJECT TO SECTION [10A] HEREAFTER WHICH PREVAILS IF YOU RESIDE IN GERMANY: TO THE EXTENT PERMITTED BY LAW, NEITHER SKYROAM NOR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, CONTRACTORS, AGENTS, AND REPRESENTATIVES SHALL IN ANY EVENT BE LIABLE TO YOU FOR ANY CONSEQUENTIAL, PUNITIVE, EXEMPLARY, SPECIAL, INCIDENTAL, OR INDIRECT DAMAGES OF ANY KIND, INCLUDING WITHOUT LIMITATION, LOSS OF DATA OR PROFITS, LOSS OF GOODWILL OR BUSINESS REPUTATION, COST OF PROCUREMENT OR REPLACEMENT GOODS AND SERVICES, COVER, OR RELIANCE DAMAGES, OR ANY OTHER TANGIBLE LOSS ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, INFRINGEMENT OF INTELLECTUAL PROPERTY, OR OTHERWISE, AND WHETHER OR NOT SKYROAM HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSS OR DAMAGE. SKYROAM AGREES THAT THESE LIMITATIONS WILL SURVIVE AND APPLY EVEN IF ANY LIMITED REMEDY SPECIFIED IN THIS AGREEMENT IS FOUND TO HAVE FAILED OF ITS ESSENTIAL PURPOSE.

Skyroam’s total aggregate liability to you from all causes of action and under all theories of liability will be limited to and will not exceed the total amount of all fees paid by you under these T&Cs. This limitation will apply notwithstanding the failure of the essential purpose of any remedy hereunder.

Section 10.a: Exceptions for Customers Residing in Europe

If you are a resident of the European Union, nothing in this Agreement shall however limit or exclude our liability:

(a) for damages (i) caused by intent or gross negligence, also by our statutory representatives and vicarious agents (“Erfüllungsgehilfen”), (ii) resulting from an injury to life, body or health, (iii) caused by fraudulent misrepresentation (“arglistig verschwiegene Mängel”) and (iv) damages resulting from a violation of a guarantee as to quality (“Beschaffenheitsgarantie”));

(b) for damages to property and financial damages (“Sach- und Vermögensschäden”) caused by slight negligence of us, our statutory representatives or vicarious agents, in the event of a violation of a contractual core duty (“wesentliche Vertragspflicht”), however limited to the amount of the damage which was foreseeable at the time of conclusion of the contract and typical, taking into User Account the nature of the contract (“vorhersehbarer und vertragstypischer Schaden”). Contractual core duties are such duties whose accomplishment enables proper fulfilment of an agreement and whose observance the contracting parties may regularly rely on; and

(c) based on the German Product Liability Act.

Section 11: Indemnification

By agreeing to these T&Cs, you agree to indemnify, defend, and hold harmless Skyroam, its officers, directors, employees, independent contractors, affiliates, representatives, agents, and other customers against any and all claims, demands, losses, costs, or expense, including but not limited to reasonable attorneys’ fees, in any way connected with (a) a culpable breach of these T&Cs; (b) any dispute between you and any third party product, service, or site, which you engaged through the Products and Services not authorized by this Agreement; and (c) which arise or result from any unauthorized or illegal use or distribution of the Product and Services.

Section 12: Miscellaneous

Skyroam reserves the right to discontinue the Products and Services or terminate and/or amend these T&Cs at any time at Skyroam’s sole discretion, including (without limitation) in the event of modifications to the Products or Services, technical changes or changes of legal regulations, provided that this will not have retroactive effect.

If you have entered into an ongoing contract with us and we change this Agreement, we will inform you of these changes at least 4 weeks in advance via email. If you do not agree with the changes, you may object via email or in writing within 4 weeks from receipt of the notice. If you do not object within that period, you shall be deemed to have approved the amended Agreement. In our notification, we will inform you about your right to object, the deadline and consequences of inaction. This does not apply to changes that would change the object of our contract with you, or the contractual main duties which would create an imbalance. In such event, we would offer you to continue our Agreement with you subject to the amended terms.

Expiration or termination of this Agreement will not relieve you of any payment obligations hereunder. Sections 6-9, 12-16 shall survive any such expiration or termination.

You may not assign or transfer any of your rights or obligations under this Agreement without Skyroam’s prior written consent. You agree that Skyroam may assign this Agreement without prior notice in the event of a merger, acquisition, or sale of all or part of Skyroam’s business.

No waiver of any breach of any provision of this Agreement shall constitute a waiver of any prior, concurrent or subsequent breach of the same or any other provisions hereof, and no waiver shall be effective unless made in writing and signed by an authorized represen­tative of the waiving party.

If any provision of this Agreement is held unenforceable or in conflict with the law of any jurisdiction, the validity of the remaining provisions shall not be affected by such holding.

This Agreement contains the entire understanding of the parties with respect to the subject matter contained herein, and shall supersede all prior agreements and understandings, whether written or oral.

Section 13: Third Party Products and Services; User Content

By using the Products and Services, you may receive promotional messages regarding Products and Services Skyroam offers, as well as other third party products, services, and advertisements, subject to your prior consent if required by applicable law.

You understand that your content (excluding payment or credit card information), may be transferred unencrypted and involve (a) transmissions over various networks; and (b) changes to conform and adapt to technical requirements of connecting networks or devices. Credit card and payment information is always encrypted during transfer over networks.

THIRD PARTY PRODUCTS AND SERVICES

Certain content, products and services available via the Products and Services may give you access to materials from third parties, such as particularly third party services which you can access through our Services. Third party links on Skyroam’s website may direct you to third party sites that are not affiliated with Skyroam. Skyroam does not warrant and will not have any liability or responsibility for any third party content, or for any other materials, websites, products, or services of third parties. Skyroam is not liable for any harm or damages related to the rental or use of goods, services, resources, content, or any other transactions made in connection with any third party websites. Please review carefully the third party's policies and practices and make sure you understand them before you engage in any transaction. Complaints, claims, concerns, or questions regarding third party products should be directed to the third party.

USER COMMENTS, FEEDBACK AND OTHER SUBMISSIONS

If, at Skyroam’s request, you send certain specific submissions (for example contest entries) or without a request from Skyroam you send creative ideas, suggestions, proposals, plans, or other materials, excluding however confidential business communication between you and us, whether online, by email, by postal mail, or otherwise (collectively, “Comments”), you agree that Skyroam may, at any time, without restriction, edit, copy, publish, distribute, translate and otherwise use in any medium any comments that you forward to Skyroam.

In addition, you agree that Skyroam may use your name and logo (whether or not you have made it available through the Products and Services) for the purpose of identifying you as an existing or past customer of Skyroam both on the Products and Services and in marketing, advertising and promotional materials.

Skyroam is under no obligation (1) to maintain any comments in confidence; (2) to pay compensation for any comments; or (3) to respond to any comments. Skyroam may, but has no obligation to, monitor, edit or remove content that Skyroam determines in Skyroam’s sole discretion are unlawful, offensive, threatening, libelous, defamatory, pornographic, obscene or otherwise objectionable or violates any party’s intellectual property or these T&Cs. You agree that your comments will not violate any right of any third party, including copyright, trademark, privacy, or other personal or proprietary right. You further agree that your comments will not contain libelous or otherwise unlawful, abusive or obscene material, or contain any computer virus or other malware that could in any way affect the operation of the Products and Services. You may not use a false e-mail address, pretend to be someone other than yourself, or otherwise mislead Skyroam or third parties as to the origin of any comments. You are solely responsible for any comments you make and their accuracy. Skyroam takes no responsibility and assumes no liability for any comments posted by you or any third party.

Section 14: Promotional Codes

Promotional codes must be used at time of purchase and cannot be exchanged for credit on previous purchases. The discount for purchases is applied to daypasses only. If applicable, enter the discount code in the indicated text field of the checkout order page, and hit "Apply". The discount will be visible immediately in the order summary. Promotional codes expire within 30 days of issue, unless otherwise specified in writing.

Section 15: Governing Law; Dispute Resolution and Arbitration

Let's Try To Sort Things Out First.

Skyroam wants to address your concerns without needing a formal legal case. Before filing a claim, you agree to try to resolve the dispute informally by contacting support_eu@skyroam.com. Skyroam will try to resolve the dispute informally by contacting you via email. If a dispute is not resolved within 30 days of submission, you or Skyroam may bring a formal proceeding. This clause is non-mandatory and shall not limit your statutory rights.

Governing Law; Judicial forum for disputes.

These T&Cs are governed by German Law, without regard to conflicts of law principles and the United Nations Convention on Contracts for the International Sale of Goods (CISG). If you are a businessman (“Kaufmann”) or a legal person, you and Skyroam agree that any judicial proceeding to resolve claims relating to these T&Cs will be brought in the courts of Berlin, Germany. Both you and Skyroam consent to venue and personal jurisdiction in such courts.

Settling of disputes: Skyroam is not obliged to participate in dispute settlement procedures before a consumer dispute settlement conciliation board and does not participate in such. Equally, Skyroam dos not participate in the online dispute resolution mechanism offerd by the European Commission under http://ec.europa.eu/consumers/odr/.

IF YOU'RE A U.S. RESIDENT, YOU ALSO AGREE TO THE FOLLOWING MANDATORY ARBITRATION PROVISIONS:

Both Parties Agree To Arbitrate. You and Skyroam agree to resolve any claims relating to these T&Cs through final and binding arbitration before one arbitrator, except as set forth under Exceptions to Agreement to Arbitrate below. This includes disputes arising out of or relating to interpretation or application of this "Mandatory Arbitration Provisions" section, including its enforceability, revocability, or validity.

Arbitration Procedures. Any dispute, claim or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in the San Francisco Bay Area before one arbitrator with substantial experience arbitrating claims relating to commercial contracts. The arbitration shall be administered by JAMS pursuant to its Comprehensive Arbitration Rules and Procedures and in accordance with the Expedited Procedures in those Rules or pursuant to JAMS’ Streamlined Arbitration Rules and Procedures. Judgment on the Award may be entered in any court having jurisdiction. This clause shall not preclude parties from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. Notwithstanding the foregoing, either party may apply to any court of competent jurisdiction for injunctive relief without breach of this arbitration provision.

Exceptions to Agreement to Arbitrate. Either you or Skyroam may assert claims, if they qualify, in small claims court in San Francisco (CA) or any United States county where you live or work. Either party may bring a lawsuit solely for injunctive relief to stop unauthorized use or abuse of the Products and Services, or intellectual property infringement (for example, trademark, trade secret, copyright, or patent rights) without first engaging in arbitration or the informal dispute-resolution process described above. If the agreement to arbitrate is found not to apply to you or your claim, you agree to the exclusive jurisdiction of the state and federal courts in San Francisco County, California to resolve your claim.

NO CLASS ACTIONS. You may only resolve disputes with Skyroam on an individual basis, and may not bring a claim as a plaintiff or a class member in a class, consolidated, or representative action. Class arbitrations, class actions, private attorney general actions, and consolidation with other arbitrations aren't allowed. If this specific paragraph is held unenforceable, then the entirety of this "Mandatory Arbitration Provisions" section will be deemed void.

Section 16: Contact Information

Questions about these T&Cs should be sent to: support_eu@skyroam.com

Model withdrawal form

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

— To Skyroam GmbH, (Skyroam GmbH, c/o WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, support_eu@skyroam.com, +49 30 726 11 894)

— I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision 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

Skyroam GmbH Terms of Service (Rental)

Last Updated: July 18th, 2017

Thanks for using Skyroam!

These terms of service and (“T&Cs,” “Agreement,”) cover your use and access to Skyroam’s wireless modem hotspot, products, accessories, services, and websites (“Products and Services” or (if in physical form) “Equipment”). This is a contract between you and Skyroam GmbH, having its registered office at WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, Germany ("Skyroam"). By using the Products and Services and agreeing to these T&C’s, you’re agreeing to be bound by these T&Cs and Skyroam’s Privacy Policy. If you are using the Products and Services for an organization, you're agreeing to these T&Cs on behalf of that organization.

For the purchase of Equipment, our separate Skyroam GmbH Terms of Service (Purchase) apply.

BEFORE YOU USE THE PRODUCTS AND SERVICES, PLEASE CAREFULLY READ THESE TERMS AND CONDITIONS SET FORTH HEREUNDER. BY USING THE PRODUCTS AND SERVICES AND AGREEING TO THESE T&Cs, YOU ARE BOUND BY AND HAVE BECOME A PARTY TO THIS AGREEMENT. IF YOU DO NOT AGREE TO BE BOUND BY THIS AGREEMENT, THEN PLEASE DO NOT CONTINUE TO USE THE PRODUCTS AND SERVICES. SKYROAM RESERVES THE RIGHT TO AMEND THESE T&Cs AT ANY TIME. YOUR CONTINUED ACCESS OR USE OF THE PRODUCTS AND SERVICES WILL CONSITITUTE ACCEPTANCE OF THE MODIFIED T&CS. SKYROAM RESERVES THE RIGHT TO REFUSE PRODUCTS AND SERVICES TO ANYONE FOR ANY REASON AT ANY TIME.

THIS AGREEMENT MAY ONLY BE SUPERSEDED BY A SEPARATE AGREEMENT WITH SKYROAM, INC. THAT EXPRESSLY REFERENCES AND SUPERSEDES THIS AGREEMENT (A “SUPERSEDING AGREEMENT”).

RENTAL TERMS:

Section 1: Products & Services

In addition to the Products and Services, Skyroam also provides a quick start guide to travelers who plan to visit the United Kingdom, Europe, Asia, or other international destinations covered by Skyroam as listed on the Skyroam website.

SERVICE THROTTLE POLICY: In order to provide quality high-speed connectivity, speed may be reduced after a certain amount of data (500MB) is reached in each 24-hour period. Activities like video streaming are not recommended as they consume a high volume of data and limit access to the network.

Section 2: Eligibility to Rent

While the Products and Services may be used by travelers of any age, Skyroam will only rent to adults who are at least 18 years of age. If you are not 18 years of age, you represent that you are at least the age of majority in your respective state or province of residence; or that you are the age of majority in your state or province of residence and you have given Skyroam your consent to allow your minor dependents to use the Products and Services.

Section 3: Delivery

When you place an order to rent, Skyroam asks that you inspect all Equipment upon receipt and to verify that it is in good working order and condition. It is your responsibility to ensure that you are available to receive and that you accept the delivery of the Equipment. Skyroam will assume all risk of loss and damage from the delivery of the Equipment from the point of rental order to your designated rental address.

Section 4: Use of Products & Services

You agree to exercise reasonable care in the use of all Products and Services, and to handle all Equipment in accordance with these T&Cs and quick start guide.

You further agree that you will NOT do any of the following:

(a) make repairs or modifications, or alter in any way, the Equipment (including but not limited to the swapping of a non-authorized Equipment battery);

(b) remove or alter any certification markers affixed to the Equipment;

(c) share the Equipment with any third party, or allow any such third party to use the Equipment, with the sole exception of a family member, companion, or friend on your trip (up to five devices);

(d) dispose of the Equipment;

(e) grant any interest in the Equipment to any third party; or

(f) use the Equipment for any illegal purpose, including in violation of your jurisdiction (including but not limited to copyright laws).

(g) use the Products and Services or its content:

(i) for any unlawful purpose; (ii) to solicit others to perform or participate in any unlawful acts; (iii) to violate any international, federal, provincial or state regulations, rules, laws, or local ordinances; (iv) to infringe upon or violate Skyroam’s intellectual property rights or the intellectual property rights of others; (v) to harass, abuse, insult, harm, defame, slander, disparage, intimidate, or discriminate based on gender, sexual orientation, religion, ethnicity, race, age, national origin, or disability; (vi) to submit false or misleading information; (vii) to upload or transmit viruses or any other type of malicious code that will or may be used in any way that will affect the functionality or operation of the Services or of any related Skyroam website, other websites, or the internet; (viii) to collect or track the personal information of others; (ix) to spam, phish, pharm, pretext, spider, crawl, or scrape; (x) for any obscene or immoral purpose; or (xi) to interfere with or circumvent the security features of the Services or any related Skyroam website, other websites, or the internet.

(h) use the Equipment to transmit worms or viruses or any code of a destructive nature.

Skyroam reserves the right to terminate your use of the Product and Services for violating any of these prohibited uses in Section 4, subject to unsuccessful expiry of a reasonable cure period set by Skyroam, or an unsuccessful prior warning, as the case may be and if so required under applicable law.

Section 5: Returns

(a) Shipping Instructions via provided pre-paid return label.

All rentals should be returned by a local mail service or other generally recognized courier service in accordance with the provided pre-paid return label and shipping instructions, and returned no later than seven (7) days following the date when your rental term ends (your “Rental End Date”). The Equipment shall be returned in good working order and condition. You assume all risk of loss and damage from the return of all Equipment to Skyroam’s designated address on the return label shipping instructions.

(b) If you go over your 7-day grace period.

If the rented Equipment is not received by the end of a 7-day grace period following the Rental End Date, you will be charged an additional $9.95/day ($11.90 with Skyroam Solis upgrade) for up to 13 days. After 13 days, you are assumed to have purchased all rented Equipment; Skyroam’s Purchase T&Cs (as listed on Skyroam’s website) will then apply for your future use of the Equipment.

If for any reason you are unable to return the Equipment (including but not limited to the Equipment being lost or stolen during the Rental Period), then you should contact the Skyroam team immediately at support_eu@skyroam.com, so that you do not incur additional late charges. If the Equipment is returned to Skyroam after you have been charged the loss penalty, Skyroam will immediately offset the charge with the fee corresponding to the number of days your Equipment is overdue.

Section 6: Fees & Charges

(a) Rental Period. Your rental period is defined as the dates you book to rent the Products and Services.

(b) Rental charges will be placed as follows:

For rentals purchased online, your order will be made through the Shopify Inc. platform. You hereby agree and consent to the policies and procedures of Shopify Inc. (“Shopify”), as further explained in Section 13 of this Agreement.

(c) Damages or Lost Equipment. Subject to Section 7 below, you are solely responsible for all loss or damage to the Equipment during the Rental Period. Any charges for damaged or lost Equipment will be billed directly to the credit card or Paypal account used at the time of rental. Charges can range from replacement parts up to the full value of Skyroam’s Equipment as listed on the Skyroam website. Damaged Equipment is defined as Equipment that is no longer fit for re-use, including cosmetic damage that significantly deteriorates the user experience (e.g. cracked screen).

Please note that Skyroam reserves the right to charge you for the full value of the Equipment or institute collection procedures against you in the event that you fail to return the Equipment as required by this Agreement or fail to pay any Service or damage charges or late fees that you incur in the event of a default. If you are in default and it becomes necessary to institute collection procedures against you, you agree to pay the reasonable costs of collection, including without limitation reasonable attorneys’ fees. Any late fees that Skyroam collects will not waive any other right or remedy that may otherwise be available to you under this Agreement.

Section 7: Ownership of Equipment; Insurance

By renting, you agree and acknowledge you are renting Equipment for travel purposes only, and that you will acquire no rights in the Products and Services except as set out expressly herein. You further agree that Skyroam will retain all ownership of the Equipment.

Section 8: Skyroam’s Quality Promise

Skyroam warrants that the Equipment will be delivered in good working order and condition as required to fulfill our agreement with you, and that it will continue to operate properly during the term of the Rental Period.

Section 9: Disclaimer of Warranties

SUBJECT TO SECTION [10A] HEREAFTER WHICH PREVAILS APPLIES IF YOU RESIDE IN GERMANY: EXCEPT FOR THE QUALITY PROMISE SET FORTH IN SECTION 9 ABOVE, SKYROAM MAKES NO REPRESENTATIONS, WARRANTIES, CONDITIONS, OR GUARANTIES, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE, ORAL OR WRITTEN, REGARDING THE EQUIPMENT OR THIS AGREEMENT. SKYROAM CANNOT WARRANT THE PRODUCTS AND SERVICES WILL OPERATE UNINTERRUPTED OR ERROR-FREE, THAT IT WILL OPERATE PROPERLY ON ALL WIRELESS NETWORKS, THAT IT WILL MEET ALL YOUR NEEDS, OR THAT ANY THAT YOU ACCESS WILL BE UNINTERRUPTED, ERROR-FREE, OR MEET YOUR NEEDS. SKYROAM CANNOT BE RESPONSIBLE FOR THE LEGALITY, ADEQUACY, ACCURACY, QUALITY, OR OPERATION OF ANY THIRD PARTY PRODUCTS OR SERVICES. SKYROAM EXPRESSLY DISCLAIMS ALL OTHER WARRANTIES WITH RESPECT TO THE PRODUCTS, SERVICES, AND ANY THIRD PARTY PRODUCTS OR SERVICES ACCESSED THROUGH THE PRODUCTS AND SERVICES, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NON-INFRINGEMENT OF THIRD PARTY RIGHTS. YOU ASSUME SOLE AND EXCLUSIVE RESPONSIBILITY FOR THE USE OF THE EQUIPMENT AND FOR ANY RELIANCE ON ANY THIRD PARTY PRODUCTS OR SERVICES.

While Skyroam will make every effort to erase all personal information left on returned Equipment, YOU ASSUME THE SOLE RISK AND RESPONSIBILITY FOR ERASING PERSONAL INFORMATION PRIOR TO RETURNING EQUIPMENT RENTED PURSUANT TO THIS T&CS AS THE EQUIPMENT IS NOT INTENDED FOR ANY STORAGE OR USE, INCLUDING BUT NOT LIMITED TO STORING PERSONAL INFORMATION AND DATA.

SKYROAM’s STRICT LIABILITY ACCORDING TO § 536a, PARA 1, 1st ALTERNATIVE OF THE GERMAN CIVIL CODE (INITIAL DEFAULT) SHALL BE EXCLUDED.

Section 10: Consequential damages; Limitation of Liability

SUBJECT TO SECTION [10A] HEREAFTER WHICH PREVAILS APPLIES IF YOU RESIDE IN GERMANY: TO THE EXTENT PERMITTED BY LAW, NEITHER SKYROAM NOR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, CONTRACTORS, AGENTS, AND REPRESENTATIVES SHALL IN ANY EVENT BE LIABLE TO YOU FOR ANY CONSEQUENTIAL, PUNITIVE, EXEMPLARY, SPECIAL, INCIDENTAL, OR INDIRECT DAMAGES OF ANY KIND, INCLUDING WITHOUT LIMITATION, LOSS OF DATA OR PROFITS, LOSS OF GOODWILL OR BUSINESS REPUTATION, COST OF PROCUREMENT OR REPLACEMENT GOODS AND SERVICES, COVER, OR RELIANCE DAMAGES, OR ANY OTHER TANGIBLE LOSS ARISING OUT OFOR IN CONNECTION WITH THIS AGREEMENT, WHETHER SUCH LIABILITY ARISES FROM ANY CLAIM BASED ON CONTRACT, WARRANTY, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, INFRINGEMENT OF INTELLECTUAL PROPERTY, OR OTHERWISE, AND WHETHER OR NOT SKYROAM HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSS OR DAMAGE. SKYROAM AGREES THAT THESE LIMITATIONS WILL SURVIVE AND APPLY EVEN IF ANY LIMITED REMEDY SPECIFIED IN THIS AGREEMENT IS FOUND TO HAVE FAILED OF ITS ESSENTIAL PURPOSE.

Skyroam’s total aggregate liability to you from all causes of action and under all theories of liability will be limited to and will not exceed the total amount of all fees paid by you under these T&Cs. This limitation will apply notwithstanding the failure of the essential purpose of any remedy hereunder.

Section 10.a: Exceptions for Customers Residing in Europe

If you are a resident of the European Union, nothing in this Agreement shall however limit or exclude our liability:

(a) for damages (i) caused by intent or gross negligence, also by our statutory representatives and vicarious agents (“Erfüllungsgehilfen”), (ii) resulting from an injury to life, body or health, (iii) caused by fraudulent misrepresentation (“arglistig verschwiegene Mängel”) and (iv) damages resulting from a violation of a guarantee as to quality (“Beschaffenheitsgarantie”));

(b) for damages to property and financial damages (“Sach- und Vermögensschäden”) caused by slight negligence of us, our statutory representatives or vicarious agents, in the event of a violation of a contractual core duty (“wesentliche Vertragspflicht”), however limited to the amount of the damage which was foreseeable at the time of conclusion of the contract and typical, taking into User Account the nature of the contract (“vorhersehbarer und vertragstypischer Schaden”). Contractual core duties are such duties whose accomplishment enables proper fulfilment of an agreement and whose observance the contracting parties may regularly rely on; and

(d) based on the German Product Liability Act.

Section 11: Indemnification

By agreeing to these T&Cs, you agree to indemnify, defend, and hold harmless Skyroam, its officers, directors, employees, independent contractors, affiliates, representatives, agents, and other customers against any and all claims, demands, losses, costs, or expense, including but not limited to reasonable attorneys’ fees, in any way connected with (a) a culpable breach of these T&Cs; (b) any dispute between you and any third party product, service, or site, which you engaged through the Products and Services not authorized by this Agreement; and (c) which arise or result from any unauthorized or illegal use or distribution of the Product and Services.

Section 12: Miscellaneous

Skyroam reserves the right to discontinue the Products and Services or terminate and/or amend these T&Cs at any time at Skyroam’s sole discretion, including (without limitation) in the event of modifications to the Products or Services, technical changes or changes of legal regulations, provided that this will not have retroactive effect.

If you have entered into an ongoing contract with us and we change this Agreement, we will inform you of these changes at least 4 weeks in advance via email. If you do not agree with the changes, you may object via email or in writing within 4 weeks from receipt of the notice. If you do not object within that period, you shall be deemed to have approved the amended Agreement. In our notification, we will inform you about your right to object, the deadline and consequences of inaction. This does not apply to changes that would change the object of our contract with you, or the contractual main duties which would create an imbalance. In such event, we would offer you to continue our Agreement with you subject to the amended terms.

Expiration or termination of this Agreement will not relieve you of any payment obligations hereunder. Sections 6-9, 12-16 shall survive any such expiration or termination.

You may not assign or transfer any of your rights or obligations under this Agreement without Skyroam’s prior written consent. You agree that Skyroam may assign this Agreement without prior notice in the event of a merger, acquisition, or sale of all or part of Skyroam’s business.

No waiver of any breach of any provision of this Agreement shall constitute a waiver of any prior, concurrent or subsequent breach of the same or any other provisions hereof, and no waiver shall be effective unless made in writing and signed by an authorized represen­tative of the waiving party.

If any provision of this Agreement is held unenforceable or in conflict with the law of any jurisdiction, the validity of the remaining provisions shall not be affected by such holding.

This Agreement contains the entire understanding of the parties with respect to the subject matter contained herein, and shall supersede all prior agreements and understandings, whether written or oral.

Section 13: Third Party Products and Services; User Content

By using the Products and Services, you may receive promotional messages regarding Products and Services Skyroam offers, as well as other third-party products, services, and advertisements, subject to your prior consent if required by applicable law.

You understand that your content (excluding payment or credit card information), may be transferred unencrypted and involve (a) transmissions over various networks; and (b) changes to conform and adapt to technical requirements of connecting networks or devices. Credit card and payment information is always encrypted during transfer over networks.

THIRD PARTY PRODUCTS AND SERVICES

Certain content, products and services available via the Products and Services may give you access to materials from third parties, such as particularly third party services which you can access through our Services. Third party links on Skyroam’s website may direct you to third party sites that are not affiliated with Skyroam. Skyroam does not warrant and will not have any liability or responsibility for any third party content, or for any other materials, websites, products, or services of third parties. Skyroam is not liable for any harm or damages related to the rental or use of goods, services, resources, content, or any other transactions made in connection with any third party websites. Please review carefully the third party's policies and practices and make sure you understand them before you engage in any transaction. Complaints, claims, concerns, or questions regarding third-party products should be directed to the third party.

USER COMMENTS, FEEDBACK AND OTHER SUBMISSIONS

If, at Skyroam’s request, you send certain specific submissions (for example contest entries) or without a request from Skyroam you send creative ideas, suggestions, proposals, plans, or other materials, excluding however confidential business communication between you and us, whether online, by email, by postal mail, or otherwise (collectively, “Comments”), you agree that Skyroam may, at any time, without restriction, edit, copy, publish, distribute, translate and otherwise use in any medium any comments that you forward to Skyroam. Skyroam is under no obligation (1) to maintain any comments in confidence; (2) to pay compensation for any comments; or (3) to respond to any comments. Skyroam may, but has no obligation to, monitor, edit or remove content that Skyroam determines in Skyroam’s sole discretion are unlawful, offensive, threatening, libelous, defamatory, pornographic, obscene or otherwise objectionable or violates any party’s intellectual property or these T&Cs. You agree that your comments will not violate any right of any third party, including copyright, trademark, privacy, or other personal or proprietary right. You further agree that your comments will not contain libelous or otherwise unlawful, abusive or obscene material, or contain any computer virus or other malware that could in any way affect the operation of the Products and Services. You may not use a false e-mail address, pretend to be someone other than yourself, or otherwise mislead Skyroam or third parties as to the origin of any comments. You are solely responsible for any comments you make and their accuracy. Skyroam takes no responsibility and assumes no liability for any comments posted by you or any third party.

Section 14: Promotional Codes

Promotional codes must be used at time of rental order and cannot be exchanged for credit on previous rentals. The discount is applied to rental fees only, not extras such as insurance. If applicable, enter the discount code in the indicated text field of the checkout order page, and hit "Apply." The discount will be visible immediately in the order summary.

Section 15. Your Right of Withdrawal

If you order Products or Services from our website as a consumer within the meaning of § 13 of the German Civil Code, you are entitled to a right of withdrawal in accordance with the following provisions (other than in the event of purchase of Equipment, for which our separate Skyroam GmbH Terms of Service (Purchase).

Information about your Right of Withdrawal

Right of Withdrawal

You have the right to withdraw from this contract within 14 days without giving any reason.

The withdrawal period will expire after 14 days from the day of the conclusion of the contract.

To exercise the right of withdrawal, you must inform us (Skyroam GmbH, c/o WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, support_eu@skyroam.com, (+49) 3072 621 8949 10 of your decision to withdraw from this contract by an unequivocal statement (e.g. a letter sent by post, fax or e-mail). You may use the attached model withdrawal form, but it is not obligatory.

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

Effects of Withdrawal

If you withdraw from this contract, we shall reimburse to you all payments received from you, including the costs of delivery (with the exception of the supplementary costs resulting from your choice of a type of delivery other than the least expensive type of standard delivery offered by us), without undue delay and in any event not later than 14 days from the day on which we are informed about your decision to withdraw from this contract. We will carry out such 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 such reimbursement.

You shall send back the goods or hand them over to us, without undue delay and in any event not later than 14 days from the day on which you communicate your withdrawal from this contract to us. The deadline is met if you send back the goods before the period of 14 days has expired.

You will have to bear the direct cost of returning the goods.

You are only liable for any diminished value of the goods resulting from the handling other than what is necessary to establish the nature, characteristics and functioning of the goods.

If you requested to begin the performance of services during the withdrawal period, you shall pay us an amount which is in proportion to what has been provided until you have communicated us your withdrawal from this contract, in comparison with the full coverage of the contract.

Section 16: Governing Law; Dispute Resolution and Arbitration

Let's Try To Sort Things Out First.

Skyroam wants to address your concerns without needing a formal legal case. Before filing a claim, you agree to try to resolve the dispute informally by contacting support_eu@skyroam.com. Skyroam will try to resolve the dispute informally by contacting you via email. If a dispute is not resolved within 30 days of submission, you or Skyroam may bring a formal proceeding. This clause is non-mandatory and shall not limit your statutory rights.

Governing Law; Judicial forum for disputes.

These T&Cs are governed by German Law, without regard to conflicts of law principles and the United Nations Convention on Contracts for the International Sale of Goods (CISG). If you are a businessman (“Kaufmann”) or a legal person, you and Skyroam agree that any judicial proceeding to resolve claims relating to these T&Cs will be brought in the courts of Berlin, Germany. Both you and Skyroam consent to venue and personal jurisdiction in such courts.

Settling of disputes: Skyroam is not obliged to participate in dispute settlement procedures before a consumer dispute settlement conciliation board and does not participate in such. Equally, Skyroam does not participate in the online dispute resolution mechanism offered by the European Commission under http://ec.europa.eu/consumers/odr/.

IF YOU'RE A U.S. RESIDENT, YOU ALSO AGREE TO THE FOLLOWING MANDATORY ARBITRATION PROVISIONS:

Both Parties Agree To Arbitrate. You and Skyroam agree to resolve any claims relating to these T&Cs through final and binding arbitration before one arbitrator, except as set forth under Exceptions to Agreement to Arbitrate below. This includes disputes arising out of or relating to interpretation or application of this "Mandatory Arbitration Provisions" section, including its enforceability, revocability, or validity.

Arbitration Procedures. Any dispute, claim or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in the San Francisco Bay Area before one arbitrator with substantial experience arbitrating claims relating to commercial contracts. The arbitration shall be administered by JAMS pursuant to its Comprehensive Arbitration Rules and Procedures and in accordance with the Expedited Procedures in those Rules or pursuant to JAMS’ Streamlined Arbitration Rules and Procedures. Judgment on the Award may be entered in any court having jurisdiction. This clause shall not preclude parties from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. Notwithstanding the foregoing, either party may apply to any court of competent jurisdiction for injunctive relief without breach of this arbitration provision.

Exceptions to Agreement to Arbitrate. Either you or Skyroam may assert claims, if they qualify, in small claims court in San Francisco (CA) or any United States county where you live or work. Either party may bring a lawsuit solely for injunctive relief to stop unauthorized use or abuse of the Products and Services, or intellectual property infringement (for example, trademark, trade secret, copyright, or patent rights) without first engaging in arbitration or the informal dispute-resolution process described above. If the agreement to arbitrate is found not to apply to you or your claim, you agree to the exclusive jurisdiction of the state and federal courts in San Francisco County, California to resolve your claim.

NO CLASS ACTIONS. You may only resolve disputes with Skyroam on an individual basis, and may not bring a claim as a plaintiff or a class member in a class, consolidated, or representative action. Class arbitrations, class actions, private attorney general actions, and consolidation with other arbitrations aren't allowed. If this specific paragraph is held unenforceable, then the entirety of this "Mandatory Arbitration Provisions" section will be deemed void.

Section 17: Contact Information

Questions about these T&Cs should be sent to:

Model withdrawal form

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

— To Skyroam GmbH, c/o WeWork, Neue Schönhauser Str. 3-5, 10178 Berlin, support_eu@skyroam.com, (+49) 3072 621 894

— I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision 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