Client Testimonial Advertising Release Form
Please complete this form to authorize the use of your testimonial for advertising and promotional purposes.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company/Organization (if applicable)
Your Position/Title
Please provide your testimonial below
*
Would you like your testimonial to be anonymous or credited?
*
Credited (use my name/company)
Anonymous (do not use my name/company)
Which types of media may we use your testimonial in?
*
Website
Social Media
Print Materials (brochures, flyers, etc.)
Video/Audio
Email Newsletters
Other
May we use your photo or likeness along with your testimonial?
*
Yes, you may use my photo/likeness
No, please do not use my photo/likeness
If you would like to upload a photo to accompany your testimonial, please do so here
Upload a File
Drag and drop files here
Choose a file
Cancel
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How long may we use your testimonial?
*
Please Select
Indefinitely
1 year
2 years
Other (please specify below)
Geographic scope for testimonial use
*
Worldwide
National
Local/Regional
Would you like to review the testimonial before it is published?
*
Yes, please send me a draft for approval
No, I trust your discretion
Signature (please sign below to authorize release)
*
Submit Release
Submit Release
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