Client Testimonial Collection Form

CLIENT TESTIMONIAL COLLECTION FORM AND RELEASE AGREEMENT

This Testimonial Collection Form and Release Agreement (the "Agreement") is entered into by and between:

Client Name:    Title:

Company Name:    Contact Email:

RECITALS

WHEREAS, Client engaged Company to provide services or products described below and may provide a testimonial describing Client’s experience; and

WHEREAS, Company desires the right to collect, record and use Client's testimonial, name, likeness and other materials in connection with Company’s marketing, promotion, sales and corporate materials on a worldwide basis; and

WHEREAS, the parties intend through this Agreement to set forth the terms governing Client’s testimonial, any associated compensation, confidentiality limitations, and the parties’ mutual representations and warranties.

SCOPE OF WORK / SERVICES

TESTIMONIAL DETAILS & CONSENTS

Date of Testimonial:    Location (city, state):

Permission to Use Name for Attribution:    By name    By title/company

Media Consent:    Photograph    Video recording    Audio recording

PAYMENT TERMS

Compensation for testimonial (if applicable):

TERM AND TERMINATION

This Agreement commences on:    and continues until:

Either party may terminate this Agreement for convenience upon written notice to the other party not less than days prior to termination.

Termination shall not affect Company’s rights to use testimonials properly obtained prior to termination in accordance with the terms herein unless the parties expressly agree otherwise in writing.

CONFIDENTIALITY

The parties acknowledge that the testimonial is intended for public marketing and is not confidential unless expressly designated in writing. Client may mark specific portions of submitted materials as confidential by clearly identifying those passages in writing at the time of submission. Company shall not disclose information expressly marked confidential except as required by law or with Client's prior written consent.

Notwithstanding the foregoing, factual statements about the business relationship, quantifiable results and Client’s name or likeness as expressly permitted herein are not considered confidential.

RIGHTS, LICENSE AND RELEASE

Client grants Company a perpetual, worldwide, royalty-free, transferable, sublicensable, non-exclusive license to reproduce, display, distribute, adapt, edit and otherwise use the testimonial, name, voice, image and attribution in any media now known or hereafter developed for any commercial or non-commercial purpose in connection with Company’s business, including advertising, websites, social media, proposals, presentations and press materials.

Client releases Company and its agents, licensees and assigns from any and all claims, demands, causes of action, liabilities and damages arising out of or related to the use of the testimonial in accordance with this Agreement, including claims for defamation, invasion of privacy, right of publicity, or other causes of action, except for claims arising from Company’s gross negligence or willful misconduct.

REPRESENTATIONS AND WARRANTIES

Client represents and warrants that: (a) Client has full right, power and authority to grant the rights and licenses granted herein; (b) the testimonial is original to Client and does not infringe the rights of any third party; and (c) Client will not submit material that is unlawful, libelous, obscene or otherwise actionable.

INDEMNITY

Client agrees to indemnify, defend and hold harmless Company and its officers, directors, employees and agents from any third-party claim, liability, loss or expense (including reasonable attorneys’ fees) arising from Client’s breach of any representation, warranty or other obligation under this Agreement.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state (or jurisdiction) selected by Company below without regard to conflict of law principles.

ENTIRE AGREEMENT

This Agreement constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether oral or written. Any modification or waiver must be in writing and signed by both parties.

CLIENT CERTIFICATION

By submitting this form and signing below, Client certifies that Client has read and understood this Agreement, has authority to grant the rights described herein, and knowingly and voluntarily grants Company permission to use the testimonial and other materials in accordance with this Agreement.

Client Contact Phone:    Client Contact Email:

ADDITIONAL INSTRUCTIONS / NOTES

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