Date ______________________

This form must be completed and returned only if the Customer wishes to withdraw from the order placed on maisonkinora.com except exclusions or limits to the exercise of the right of withdrawal according to the applicable General Conditions of Sale.

For the attention of Micro-enterprise, MAISON KINORA

3 Rue Gaston Darboux, 18e Arrondissement

I hereby notify the withdrawal of the contract relating to the property below:

– Order of (indicate the date)

– Order number: …………………………………….. ……………

– Client name : ……………………………………… …………………………

– Customer’s address: …………………………………….. ……………………..

Signature of the Client (only in the event of notification of this form on paper)