Your order/invoice number:
If you want to cancel the contract, please call us or fill out this form and send it to us:
Ontaria GmbH, Langendellschlag 68, 65199 Wiesbaden, Germany, Tel: +49 (0)160 977 25 149, , Email : info@ontaria.de
I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods:
(*) the provision of the following service:
(*) Ordered on / received on:
Name of the consumer(s)(*) :
Address of the consumer(s)(*):
Signature of the consumer(s)(*):
(only for paper messages)
Date:
(*) Delete as applicable