Annex: 

 

Withdrawal form 

(to be completed by the consumer,

and to be sent by registered letter with acknowledgment of receipt,

within a maximum period of 14 days following the date of conclusion of the service contract)

 

 

Withdrawal form

 

To the attention of :

Orange Utan

located at: 11 Avenue de Laon, 51100 REIMS

telephone number: 0353131919

email address: contact@orange-outan.fr

 

I hereby notify you of my withdrawal from the contract relating to ....................., ordered on:  .........

 

Consumer's first and last name: .................

Consumer's address: .................

 

Date : ..................

 

Signature of the consumer: