Please complete and return this form only if you wish to withdraw from the contract..

I, the undersigned,

– Customer’s full name: …………………………………………………………………………………………………………………

hereby declare that I exercise my right of withdrawal for the following order:

– Order number: ……………………………………………………………………………………………………………………………

– Date of order / date of receipt of order : ……………………………………………………………

Customer address: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Done on: …………………………………………..                                              To: ………………………………………………

Customer signature:

Return this form to:                                              Return the goods to:

MAROT DE LA GARAYE                                                    MAROT DE LA GARAYE

2 Rue Ambroisine Garnier Leray                                     2 Rue Ambroisine Garnier Leray

ZI SUD EST                                                                         ZI SUD EST

35 000 Rennes                                                                     35 000 Rennes                                                     

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