DIY Legal Forms

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Permission To Use Quote Or Personal Statement

FOR GOOD CONSIDERATION, the undersigned irrevocably authorizes [Name], and its successors and assigns to use, publish or reprint in whole or in part the following statement, picture, endorsement or quotation:

(Full desciption)

This authorisation shall extend only to a certain publication known as [Name and Descition], including all new editions, reprints, advertisements, publicity and promotions thereto of said work.

Dated:

Signed:__________________

[Your Name]

[Your Title]

[Your Phone Number]