I agree as follows:
(1) I authorize Dwight W. Andrus Insurance, Inc. (“Andrus Insurance”) to use my testimonial provided herewith together with my name on its web site or in any advertising or promotion of Andrus Insurance or its products or services in any medium or mode of communication, including without limitation, the Internet, printed materials, social media advertising or posts, radio and television.
(2) If this authorization and release is given on behalf of an entity, such as, but not limited to, a corporation, limited liability company or partnership, I understand and agree that the entity’s name, my title on behalf of such entity, and if applicable, the entity’s logo, will NOT be disclosed in conjunction with my testimonial and name.
(3) I hereby waive any right to inspect or approve any finished web page, ad copy, video, soundtrack, printed or electronic matter in which my testimonial, name or other authorized information may be used.
(4) I agree that my testimonial and the other information authorized to be used hereunder may be used indefinitely from the date I sign this authorization and release unless I request otherwise.
(5) I hereby certify that my testimonial of Andrus Insurance’s product(s) or service(s) is true and accurate and reflect(s) my personal experience and honest belief in the quality of the product(s) or service(s) that I am endorsing. I am providing this testimonial of my own free will and I have not been paid a monetary sum for doing so.
(6) I hereby certify that I am over eighteen years of age and competent to contract in my own name or, if applicable, on behalf of any entity for which I am granting this authorization and release.
(7) I understand that this Testimonial Authorization and Release may not be amended without my written consent or the written consent of any entity for which it is granted and the written consent of Andrus Insurance.
(8) I have read this Testimonial Authorization and Release form before affixing my signature, whether in electronic or handwritten form, and warrant that I fully understand its contents and I am signing it voluntarily. I consent to the use of electronic signatures and electronic contracting, transmittal and delivery of this Testimonial Authorization and Release form, whether on a website or through electronic mail, facsimile or through other electronic means, and an electronically signed or authenticated version of this authorization and release shall have the same legal effect as a manually signed paper original. I acknowledge that I have the ability to read, save or print this document on my computer or other device.
(9) I hereby release Andrus Insurance and its officers, employees, directors, agents and representatives from any and all claims and damages arising out of or in connection with the use of my testimonial, name, entity name and logo for any advertising or promotional materials in any medium, including, without limitation, on the Internet, through websites, social media, electronic or printed materials, television, radio, videos, or soundtracks.