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)