Testimonial Ad Release and Approval Document

Advertiser/Company Name: Contact Person: Contact Email: Contact Phone:

Testimonial Details

Testimonial Provider Name: Role/Relationship: Testimonial Text: Intended Use (Media, Duration, etc.):

Terms and Conditions

Approval and Release

I hereby give approval for the use of my testimonial as described above.
Testimonial Provider Signature:
Date:
Advertiser/Company Representative Signature:
Date: