WITHDRAWAL FORM

 

Please fill in this form and send it via email to the attention of LANCEL (e-mail address:

assistance@lancel.fr) only if you wish to withdraw from the contract.

 

I/we hereby notify my/our withdrawal from the contract referring to the following item:

Order number: ………………………………………………………………………………………….

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

Name of the purchaser(s): ……………………………………………………………………………….

Address of the purchaser(s): …………………………………………………………………………...

……………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………. Signature of the purchaser(s):

(required only if this form is notified on paper)

 

Date: …………………………………………

 

_ (*) Delete as applicable