WITHDRAWAL MODEL
To: Marcin WISNIECKI EI, Rue du Faubourg Saint-Lazare, 59600 Maubeuge, France
Email: wiesmarcin@inbox.eu

I/We give notice of withdrawal from the following service contract: [service / reference]
Contract concluded on: [date]
Name and address of consumer(s): [complete]
Date: [complete]
Signature, only for a notice on paper: [complete]