Withdrawal Form

Please fill out and send this form only if you wish for a withdrawal.

For the attention of Laboratoires Ravene, Groupe Audevard, 37 39 rue de Neuilly à 92110 Clichy.

I hereby notify you, with this form, of my wish to withdraw the contract regarding the sale mentionned below:

Order number:

Order placed on the:

Received on the:

Customer name:

Customer address:

Customer’s signature (only in the event of this form being notified on paper) :


Please sent this post as a registered letter with delivery receipt.