Retraction form

To the attention of Joue le Jeu Vaison, 40 B Avenue Victor Hugo, 84110 Vaison-la-Romaine , 06-75-68-27-76 and jouelejeuvaison@hotmail.com  :

I/we (*) notify you (*) by my/our present (*) contract retractation on the product  (*) below :

Ordered on (*)/Received on (*) :

Consumer(s)' name(s):

Consumer(s)'s adress:

Consumer(s)'s signature (only for the notification on the present paper) :

Date :

(*) Cross out the unnecessaries mentions.