RELEASE FORM

Print out the following form, sign it and fax or mail or email it to The Oil Medics LLC. We cannot use your material without this signed release form.

The Oil Medics LLC
22818 Indian Trail Dr.
Justin, TX. 76247
P: 940.206.3449  F: 214.853.5607

Your Email:_____________

I, ____________________________, individually, or on behalf of ______________________, hereby grant to The Oil Medics LLC., a Texas Limited Liability Company, an irrevocable license to use the enclosed (whether singular or plural) digital or print image, trademark, service mark, photograph and/or other copyrighted materials now or at any time in the future, throughout the world in any manner it so chooses and in any medium now known or later developed. Such license shall include any and all forms of print, hard, electronic or audio media, specifically but without limitation, use on The Oil Medics LLC labels, magazine advertisements, corporate brochures, or any other promotional material it wishes. I acknowledge that The Oil Medics LLC. is under no obligation to use the attached material.

I agree that there are to be no fees, commissions or royalties paid to me or anyone else for the use of the attached material, nor am I or any third party entitled to any revenue generated directly or indirectly herefrom.

I acknowledge and agree that I have the exclusive right and authority to grant this license, or I am authorized by ________________________ to grant the use of the attached protected intellectual property.

The Oil Medics LLC. is not responsible for loss or damage to any material herewith submitted.

Please PRINT the following information. Be sure to include your signature at the bottom.

Name ____________________________________________________________

Address ___________________________________________________________

City _______________________________________________________________

State ____________________________    Zip  _____________________________

E-Mail Address _______________________________________________________

Telephone ___________________________________________________________

Gallery Photo # (if applicable) ____________________________________________

Photographer’s Name __________________________________________________

Description of Photo/Material ___________________________________________________

Trademark/Servicemark/Copyright or other information, whether state or federal ___

____________________________________________________________________

Signature (title) ____________________________    Date  ____________________

(IMAGE/MATERIAL ATTACHED)