LE PRIVÉ — MODEL WITHDRAWAL FORM
Membership terms version: 2026-10-12

Complete and send this form only if you wish to withdraw from an eligible contract.
Use of this form is not compulsory: any unequivocal statement of withdrawal may be sent.

To: MERCACIO GROUP SL (NIF B75917252), trading as Revenue, operating Le Privé
Registered address: Avda Chipiona, Calle Bobadilla, Número 24, 11408 Cádiz, Spain
Email: legal@leprive.net

I hereby give notice that I withdraw from my contract for the provision of:
Membership / service: ______________________________________________
Ordered on / contract concluded on: ________________________________
Name of consumer: _________________________________________________
Address of consumer: ______________________________________________
___________________________________________________________________
Account email / order reference (optional): ________________________
Signature of consumer (only if sent on paper): _____________________
Date: _____________________________________________________________

Send to the postal or email address above. Do not include passwords or payment-card details.
Immediate activation of an ongoing membership does not, by itself, extinguish statutory withdrawal rights.
Terms: https://www.leprive.net/legal/membership-terms