Website Image Waiver Form - Serving Dentists Throughout the World

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Agreement for limited use of chrisad supplied original photographic/art images & materials.

Proceed with Waiver*

I understand that I will be accepting the following photography, photos or artwork from chrisad under very specific, limited and restricted use conditions.

Practice Information

Name*

First Last

Practice Name*

Email*

Date*

Description of photographic/artwork*

Specific authorized medium or media use*

I agree not to copy or otherwise retain or distribute the aforementioned original photographs or art elements or related images to any person (including the above noted chrisad client) or entities in any form... except as related to the use specifically outlined above.

As it pertains, I agree to return any artwork, magnetic media or other elements belongings to chrisad in a timely manner.

I (the undersigned) understand that any other use of the chrisad supplied photographs or art elements or related images than outlined herein will be in strict violation of this agreement...and that I will be aggressively pursued on both criminal and civil avenues for such a violation.

Email Address to Send Imagery*

Date*

It is important to finalize your marketing upgrades early and begin the printing process so we don’t miss optimal marketing periods.

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Name

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Practice Information

Christopher Gonzalez

Practice Growth Analyst

Kevin McCullogh

Practice Growth Analyst