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			ANNULATION DE COMMANDE / CANCELLATION OF THE AGREEMENT

Si vous annulez votre commande, vous pouvez utiliser le formulaire d&eacute;tachable ci-dessous. / To cancel your agreement, please complete the detachable form below

CONDITIONS : Compl&eacute;ter et signer ce formulaire. L&rsquo;envoyer par lettre recommand&eacute;e avec avis de r&eacute;ception. Utiliser l&rsquo;adresse figurant ci-dessus. L&rsquo;exp&eacute;dier au plus tard le quatorzi&egrave;me jour &agrave; partir du jour de la commande ou, si ce d&eacute;lai expire normalement un samedi, un dimanche ou un jour f&eacute;ri&eacute; ou ch&ocirc;m&eacute;, le premier jour ouvrable suivant. 
			CONDITIONS : Complete and sign this form. &nbsp;Send it by recorded delivery registered letter. Use the address printed above. &nbsp;Mail it at the latest on the fourteenth day following the date of the order or, should this period expire on a Saturday, a Sunday or a public holiday, on the first working day following.&nbsp;

Code de la consommation - art. L.121-23 &agrave; L121-26 / Articles L121-23 to L.121-26 of France&#39;s Consumer Protection Code 
			Adresse compl&egrave;te et exacte &agrave; laquelle le coupon devra &ecirc;tre retourn&eacute; / Full and accurate address to which the form should be returned :

Nom / Name :

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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						<td>{% textarea_tag name=&quot;64fe2fbc&quot; data_width=&quot;70&quot; rows=&quot;1&quot; data_label=&quot;Nom de l&#39;agence&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nom de l&#39;agence&quot; data_textarea_value=&quot;INFO_CLIENT_enseigne&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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Adresse / Adress :&nbsp;

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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						<td>{% textarea_tag name=&quot;d345c4f5&quot; data_width=&quot;70&quot; rows=&quot;1&quot; data_label=&quot;Adresse de l&#39;agence&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Adresse&quot; data_textarea_value=&quot;INFO_CLIENT_adresse&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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T&eacute;l /Phone&nbsp;:

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						<td>{% textarea_tag name=&quot;5d9ed1ee&quot; data_width=&quot;40&quot; rows=&quot;1&quot; data_label=&quot;T&eacute;l&eacute;phone de l&#39;agence&quot; data_map_field=&quot;nomap&quot; data_help=&quot;T&eacute;l&eacute;phone agence&quot; data_textarea_value=&quot;INFO_CLIENT_telephone&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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E-mail / Email :

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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						<td>{% textarea_tag name=&quot;9b4ce0de&quot; data_width=&quot;70&quot; rows=&quot;1&quot; data_label=&quot;E-mail de l&#39;agence&quot; data_map_field=&quot;nomap&quot; data_help=&quot;E-mail agence&quot; data_textarea_value=&quot;INFO_CLIENT_email&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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Je soussign&eacute;, d&eacute;clare annuler la commande ci-apr&egrave;s / &quot;I, the undersigned, hereby cancel agency agreement number : 
			Nature du bien ou du service command&eacute; / Type of service requested : 
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			Date de la commande / Date of the agreement &nbsp;:&nbsp;.............................................. 
			Nom du client / Client&#39;s name&nbsp;: 
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			Adresse du client / Client&#39;s address&nbsp;: 
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			Date :&nbsp;............................... 
			Signature du client / Client&#39;s signature :
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