Chicken litter fertilizer, seed sales, nitrogen application, custom application, soil testing and crop protection. | Phone: (712) 286-5700 | Office Location: 4949 Hwy 71 Rembrandt IA 50576

Testimonial

(1) I authorize the use of my name and likeness, together with my endorsement or testimonial, whether written or oral, which may appear in any media released by Farm Nutrients, their agents, and/or representatives in connection with my advertisement or promotion of Farm Nutrients products and or services. (2) I understand that my name, and as applicable, my title, and company name will be disclosed in conjunction with my testimonial or endorsement. (3) I agree that Farm Nutrients may copyright my endorsement or testimonial in its name or any other name it may choose. (4) I authorize Farm Nutrients and/or its representatives to use, reproduce, exhibit, and distribute any promotional materials containing my name and likeness, together with my endorsement or testimonial, for the purpose of endorsing their products and/or services. (5) I agree that Farm Nutrients and/or its representatives own all rights, including the copyright in and to any videos, still photographs, and any other material made by Farm Nutrients, its representatives or agents which contains my name, likeness, endorsement, or testimonial. (6) I hereby waive the right to receive any payment or other consideration for signing this release and waive the right to receive any payment or other consideration for use by Farm Nutrients and/or its representatives of any of the material described above. (7) I hereby waive any right to inspect or approve the finished video, soundtrack, ad copy, printed or electronic matter that may be used. (8) I agree that my testimonial may be used perpetually from the date indicated below. (9) I hereby certify that my endorsement or testimonial of Farm Nutrients product(s) is true, accurate, and reflect(s) my personal experience and honest belief in the quality of the product(s) that I am endorsing. I am doing this testimonial of my own free will and have not been paid a monetary sum for doing so. (10) I hereby certify that I am over twenty-one years of age and am competent to contract in my own name. (11) I understand that this Testimonial Release Form may not be amended without my written consent and the written consent of Farm Nutrients. (12) I have read the foregoing Testimonial Release Form before affixing my signature and warrant that I fully understand its contents and I am signing it voluntarily. (13) I hereby release Farm Nutrients, its employees, board of directors, and agents from any and all claims and damages arising out of or in connection with the use of my endorsement including any photographs, videos, soundtracks, or ad copy. (14) Limit of one pair of gloves per household.