Cancellation form

Please copy this text in the order cancellation form below and add your information:

I, the undersigned, Ms./Mr.____________________________

residing at: - Street: - City: - Zip code: - Country: - Phone number (landline or mobile): - Email address: -

hereby notify VALICOM & DECO / Kumiko Matcha, whose headquarters is located at 38 rue Le Laboureur 95160 Montmorency – France, of my cancellation of the sales contract for the aricles below:

‐ Order number:

‐ Date of order delivery:

‐ Delivery address (if different from billing address):

The (date)

at (location)

Signature