Please fill out and send this form only if you wish for a withdrawal.
For the attention of Laboratoires Ravene, Groupe Audevard, 42/46 rue Médéric à 92110 Clichy.
I hereby notify you, with this form, of my wish to withdraw the contract regarding the sale mentionned below:
Order placed on the:
Received on the:
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.