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Sample revocation form

Sample revocation form

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 :

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)


(*) Delete as applicable