Permission To Reproduce
Copyright Protected Material

- Print this out (one for each picture) and have signed by photographer or studio -

I am/we are the sole copyright owner(s) of a photo, digital or artistic image identified as:

 

My signature below acknowledges that my authority is clear and my permission is granted to:

 

to reproduce this image for the one time specific purpose of:

 

Photographer/
Artist/Studio:		 _____________________________________
Authorizing
Signature:		 _____________________________________
Title _____________________________________
Company: _____________________________________
Address: _____________________________________
City/St/Zip: _____________________________________
Phone: _____________________________________
Date: _____________________________________