Revocation form

To:

portatronics Jan Fuerstenberg

Dorotheenstr. 34
53111 Bonn
Deutschland
Telefon:: +49228631627
Telefax:: +4922896399265
http://www.portatronics.de
E-mail:: support@portatronix.de
Unsere Umsatzsteuer ID: DE259171620

iThe present form will be sent to the e-mail-address of the on the left listed shop owner.
The mail will also be sent to your below indicated e-mail-address for your record.

If you have got a customer account with us, please log in - if you haven't done so already - and your customer data will be filled in automatically.


My customer data:


Herewith I/we revoke the with you closed contract
about the purchase of the following goods / the provision of the following services:


+ more items

– less items


+ more order numbers

– less order numbers


Account data:


Security code: Captcha

This mail will also be sent to your above indicated e-mail-address.

Fields marked with * are mandatory fields.

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