Social Media Photo Release Form
Web Designs By Lorenzo
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SPECIAL INSTRUCTIONS
*
Authorization, Release, and Consent
Web Designs By Lorenzo
Can we use your name?
*
Complete name
First name
Nickname
Anonymous
Business Name
Web Designs By Lorenzo Authorization Form
*
I authorize and grant {Web Designs By Lorenzo} to take my photos regarding my experiences with them.
I grant {Web Designs By Lorenzo} to use my photos on Facebook, Twitter, Instagram, and other social media platform.
I allow {Web Designs By Lorenzo} to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos belong to the customer as well as {Web Designs By Lorenzo}.
My Products
*
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CUSTOM DESIGNS (Labor Cost)125.00
$
125.00
Price Varies Custom design pictures Instagram post, Facebook Banner, Twitter post, website banner, & more. $50.00 and up customdesign@WEBDESIGNSBYLORENZO.US Subject: Custom Design
1.Custom/2.Animation/3.Commercial
1
2
3
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Signature
Clear
Date Signed
*
-
Month
-
Day
Year
Date
Submit
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