This is the standard withdrawal form required by Article L.221-5 of the Code de la consommation, reproducing the model set out in the Annexe to Article R.221-1. The French text below is the authoritative version, prescribed by decree and reproduced word for word. The English translation beneath it is provided for comprehension only and has no legal effect.
You do not have to use this form. You may withdraw by any other unambiguous statement, for example by email to legal@theclubcult.com. Using this form is not a condition of exercising your right of withdrawal — see the Cancellation and Refund Terms.
You can also download this form as a PDF.
MODÈLE DE FORMULAIRE DE RÉTRACTATION
(Veuillez compléter et renvoyer le présent formulaire uniquement si vous souhaitez vous rétracter du contrat.)
A l'attention de :
AGENCY CULT SASU
44 Rue du Bac, 75007 Paris, France
legal@theclubcult.com
Je/nous (*) vous notifie/notifions (*) par la présente ma/notre (*) rétractation du contrat portant sur la vente du bien (*)/pour la prestation de services (*) ci-dessous :
Commandé le (*)/reçu le (*) : ___________________________
Nom du (des) consommateur(s) : ___________________________
Adresse du (des) consommateur(s) : ___________________________
Signature du (des) consommateur(s) (uniquement en cas de notification du présent formulaire sur papier) : ___________________________
Date : ___________________________
(*) Rayez la mention inutile.
MODEL WITHDRAWAL FORM
(Complete and return this form only if you wish to withdraw from the contract.)
To:
AGENCY CULT SASU
44 Rue du Bac, 75007 Paris, France
legal@theclubcult.com
I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract for the sale of the following goods (*)/for the supply of the following service (*):
Ordered on (*)/received on (*): ___________________________
Name of consumer(s): ___________________________
Address of consumer(s): ___________________________
Signature of consumer(s) (only if this form is notified on paper): ___________________________
Date: ___________________________
(*) Delete as appropriate.
For a consumer-rights matter or a complaint contact legal@theclubcult.com. This form and the right it exercises are governed by French law.