MODEL WITHDRAWAL FORM
To: Bastien Dalle — Akiyoeiko (EI), Résidence du Champ de Mars, 89 avenue Jean Moulin, 34500 Béziers, France — contact@ruleshift.eu
I hereby give notice that I withdraw from my contract of sale of the following goods:
Goods:
Ordered on / received on:
Order number (if available):
Consumer name:
Consumer address:
Date:
Signature (only for paper notifications):