Pattern-cancellation form

(If you the contract recalled want, then you fill out please this form and send you back it.)

- At Mediterranean delicacies Walter Schmacher, Weinberg 125,A-9133 Sittersdorf,, Fax: +436643946777

- Recalls hereby (n) I/we (*) of me/us (*) final contract over the purchase of the following goods (*) the /die contribution of the following service (*)

- / ordered to (*) to (*)

- Name/the consumer (s)

- Address/the consumer (s)

- Signature/the consumer (s) (only when report on paper)

- Date