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Withdrawal Form

(complete and return this form only if you wish to withdraw from the contract)

To:

For customers in the United States or Canada:

Chamilia, LLC

Attn: Chamilia Returns

One Kenney Drive

Cranston, RI 02920

For customers outside of the United States and Canada:

Chamilia Europe Limited

Attn: Chamilia Returns

Unit 48, Hoults Yard, Walker Road

Newcastle Upon Tyne, NE6 1AB

I/We* hereby give notice that I/We* withdraw from my/our* contract of sale of the following goods:

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.