Short-Form Consumer Testimonial Release in Advertising

Please ensure to review and sign this form to provide your consent for the use of your testimonial by [Your Company Name].

Personal Information
Full Name:	[Name]
Address:
Phone Number:
Email Address:

Testimonial Information
Product/Service:	[Product Name]
Date of Use:	[Month Day, Year]
Testimonial Date:	[Month Day, Year]

Testimonial Release Agreement

I, [Name], hereby grant [Your Company Name] the right to use my testimonial, given on [Month Day, Year], regarding [Product Name] for the purpose of advertising and promotion. I understand that this may include the use of my testimonial in print, online, and in other media formats.

By signing this release, I confirm that my testimonial is based on my true and honest opinion and experience with the product/service and that I have not been compensated in any way for this testimonial. I also acknowledge that [Your Company Name] may edit my testimonial for clarity or brevity, provided that the edited version remains true to my original statement.

I agree that my testimonial as given, or as edited, may be used by [Your Company Name] without any time restriction and without the payment of any fees.

Consent and Release

I hereby release and hold harmless [Your Company Name] from any claims, demands, or causes of action that I may hereafter have for defamation, invasion of privacy, or any other reason arising from the authorized use of my testimonial as outlined in this agreement.

[Name]

[Month Day, Year]

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