Annexe 3 : Retraction Form

If the Customer wishes to exercise his right of withdrawal – in accordance with the conditions set out in Article 12 of these General Terms and Conditions – he may use the form below:

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For the attention of :

I hereby notify you of my withdrawal from the contract for the following services:

-Name(s) and reference(s) of order(s) :

-Ordered on :

Name of the customer placing the order :

Address of the customer placing the order :

Signature of customer :