MODEL WITHDRAWAL FORM

(If you want to withdraw from the contract, please fill out this form and send it back)

To

Norbert Stein Pata Music

Humboldtstr. 26

50676 Koeln

mail@patamusic.de

I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),

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Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________

Address of consumer(s)

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_________________________________

_________________________________

_____________________ _____________________

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

(*) Delete as appropriate