Withdrawal form

For the attention of Around Midnight, 21 rue Monnier – 75009 – Paris- France, 01 42 81 17 28, boutique@autourdeminuit.com:

I hereby notify you of my withdrawal from the contract relating to the sale of the property below :

………………………………………………………………………………………… (add here the reference of the ordered product)

I ... U.S (*) notify you (*) hereby my/our (*) withdrawal from the contract relating to the sale of the property (*)/for the provision of services (*) below :

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

Name of (from) consumer(s) :

Address you (from) consumer(s) :

Signature of (from) consumer(s) (only in case of notification of this form on paper) :

Date :

(*) Strike out the unnecessary mention.