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: ___ / ___ / ___