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Terms and conditions of sale

17. Withdrawal form

WITHDRAWAL FORM

Please complete and return this form if you wish to exercise your right to withdraw from an order placed on the www.motoblouz.com website:

To

- D3T DISTRIBUTION
- Société par Actions Simplifiée with a capital of 9 195 €uros
- Registered with the RCS of Lille Métropole under n°478 566 250
- Address: 72 rue Elie Cartan 62220 CARVIN
- Telephone: 0321433304
- E-mail: contact@motoblouz.com

I hereby notify you of my withdrawal from the contract for the sale of the goods detailed below:

- Ordered on :
- Received on :
- Order number :
- Customer name :
- Customer address :

Made on :

A :

Customer's signature (only in the case of notification of this form on paper)