Withdrawal form

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

- To AlpinStore, Service Retour , 35 rue Principale, 57550 VILLING , France , contact@alpinstore.com

- I / We (*) hereby notify(ies) my / our (*) withdrawal from the contract for the sale of the good (* ) / for the services (*) below

- Ordered on (* ) / received on (*)

- No. of order

- Name of consumer(s)

- Address of consumer(s)

- Signature ( of ) consumer ( s) ( only if notification of this form on paper )

- Date

(*) Strike out inapplicable.