WITHDRAWAL FORM

(Please fill this form and send it back only if you would like to cancel this contract.)

To : Atelier-Boutique MALAM, 8 place des Pêcheurs, 58400 La Charité sur Loire, France – contact@malam.fr :

I/We (*) am/are (*) notifying you herewith my/our (*) withdrawal from the contract related to the sale of the goods (*)/ the ordered services (*) below :

Ordered on (*)/received on (*) :

Name of the client(s) :

Address of the client(s) :

Signature of the client(s) (only if this form is being sent back on paper through post) :

Date :

(*) Delete as appropriate.

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