Withdrawal form

To exercise your right of withdrawal, please complete the form below.

You have a period of fourteen (14) clear days from receipt of your products to exercise your right of withdrawal.
You will then be contacted by email by our team to explain the procedure to follow.
Your request is deemed to have been made on the date this form is submitted (Art. L221-21 of the French Consumer Code).

First Name*
Last Name*
Address
Zip Code
City
Country
Email Address*
Order Number*
Order Date
Delivery Date
For each product covered by your withdrawal, please provide the following details in the ‘Items concerned’ box below: the item’s reference number and description, the quantity being returned, and the return code.

Return codes:
AOT: Order arrived too late
CNL: No longer want the item
DAS: Damaged in transit
IPR: Wrong product delivered
OTH: Other reason (please specify)
Articles*
Product Reference Product Description Quantity Returned Return Code
Droit*
- I hereby exercise my right of withdrawal in respect of the order specified above.

Fields marked with (*) are required

The information collected via this form is required to process your withdrawal request, based of the performance of the contract (Article 6.1.b. of the General Data Protection Regulation) and to comply with our legal obligations regarding the right of withdrawal provided by the French Code de la Consommation.
When you are logged into your customer account, certain data (surname, first name, contact details, email) is automatically pre-filled using the information already stored in your customer account.
The data collected is intended for LPG SYSTEMS and its logistics subcontractor to record and process your withdrawal request; organise the return of the products and issue your refund in accordance with the applicable legal conditions. It is retained for the period necessary to process your request, then archived in accordance with our legal obligations, in particular our accounting obligations.
In accordance with the provisions of the current French Data Protection Act and the General Data Protection Regulation, you have the right to object to, restrict, access, rectify, transfer and erase data concerning you. You may also provide instructions regarding how you wish your rights to be exercised after your death. To exercise your rights, you may submit a request to the email address dataprivacy@lpgsystems.com or to the postal address: LPG SYSTEMS, Data Protection Officer, Technoparc de la Plaine, CS90035, 30 rue du Docteur Abel, 26902 Valence Cedex 9.
You may also lodge a complaint with the CNIL or any other competent supervisory authority.
For further information, please consult our Data Protection Policy.

Product Reference	Product Description	Quantity Returned	Return Code