Withdrawal form

Ami Paris SAS (Société par Actions Simplifiée) [a simplified joint stock company], 54 Rue Etienne Marcel, 75002, Paris, France

Return this form via email to customercare@amiparis.fr

I/We* now give notice that I/we* terminate my/our* contract for the sale of the following goods*/for the provision of the following service*: ....................................................................................................

Ordered on*/received on*: ...................................................

Customer names: ...................................................

Address of the customer(s): .......................................................................................................................................................

Signature of the customer(s) (only if this form is submitted in hard copy): ...................................................

Date: ...................................................

*Delete as appropriate