D&S Creative Inc. / dba D/LUCA
15327 De Pauw St., Pacific Palisades 90272, CA
United States
E-Mail: love@d-luca.com

I/We (*) hereby give notice that I/We (*) cancel my/our (*) contract of sale of the following goods (*) /for the supply of the following service (*),

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Ordered on (*) ____________ / received on (*) __________________

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Name of consumer(s)

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Address of consumer(s)

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Signature of consumer(s) (only if this form is notified on paper)

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Date

(*) Delete as appropriate