Cancellation form (Please complete and return this form only if you wish to withdraw from the contract.)
For the attention of
Lombardo Micro entrepreneur,
4 rue du poilu, 06230,
Villefranche sur mer
I / we (*) hereby notify you (*) of my / our (*) cancellation of the contract for the sale of the goods (*) / for the provision of services (*) below:
Ordered on (*) /
received on (*):
Name of Client (s):
Address of the Client (s):
Signature of the Client (s) (only in case of notification of this form on paper):
Date: