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To the attention of Maison Ullens, 346 rue Saint Honoré, 75008 Paris.

I/We (1) hereby notify you (1) of my/our (1) withdrawal from the contract for the sale of the good (1)/for the provision of the service (1) below : 

- Ordered on (1)/received on (1):

- Name of the consumer(s):

- Address of the consumer(s):

Signature of the consumer(s) (only if this form is notified on paper)


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