Withdraw contract

You can use this form to submit an online request for withdrawal from the contract.

Please complete the information below so that we can identify your request and send you an acknowledgement of receipt. Submitting this form does not mean that your withdrawal has been accepted.

Your request will be assessed in accordance with the withdrawal rules applicable to your contract.

Name

Last name

E-mail address

Subscription

Customer Number

Contract number

Subscription Order date

Equipment receipt date

Text comment

Please check the information you have provided before confirming your withdrawal request.

By clicking on "Confirm withdrawal", you confirm that you wish to submit an online request for withdrawal from the contract or offer identified in this form.

Your request will be assessed in accordance with the withdrawal rules applicable to your contract.

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