Standard withdrawal form

Please complete just this form and send it back if you wish to withdraw from the agreement.

— To BELION / Les Savons Gourmands, Chaussée de Liège 297/2, 5100 Jambes, Belgium, les.savons.gourmands@gmail.com:

— I/We (*) hereby inform you that I/we (*) withdraw from the agreement concerning the sale of the following goods/performance of the following service (*):

— Ordered on (*)/Received on (*)

— Name(s) of consumer(s)

— Address of consumer(s)

— Signature(s) of consumer(s) (only if paper version of this form is lodged)

— Date

(*) Delete as appropriate.