(Please complete and return this form only if you wish to withdraw from the contract.)

To the attention of :

The Dark Store
5 rue Lasalle
57000 Metz

e-mail :

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 the consumer (s):

Address of the consumer (s):

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



(*) Delete the useless mention.