Retraction form

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

For the attention of the individual company OCOLIA represented by Hélène-Cécile LEMAHIEU, 17, rue Basse 80110 FRESNOY-EN-CHAUSSEE.

I hereby notify you of my withdrawal from the contract for the sale of the following property:

_____________________________________________________________________________________________________________________________

Ordered on: ___ / ___ / ___

Name of consumer: ________________________________________________________

Consumer address: ______________________________________________________
 

Date: ___ / ___ / ___