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Home/Model Withdrawal Request

Consumer request

Model Withdrawal Request

Use this model only where a statutory withdrawal right applies.

Last updated: 20 July 2026

Send to

Stéphane Dupont — HypnoReset, 12 rue de la Part-Dieu, 69003 Lyon, France.

Email: contact@hypnosereset.com.

Suggested wording

I hereby give notice that I withdraw from my contract for the following service:

  • Service purchased: ____________________
  • Order or payment reference: ____________________
  • Order date: ____________________
  • Customer name: ____________________
  • Customer address: ____________________
  • Date: ____________________

Limits

A withdrawal right may not apply after a service has been fully performed when the customer expressly requested early performance and acknowledged the legal consequence, where permitted by applicable law.

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