Tri-Box® Food Carrier, (DBA Tri-Box, LLC)
Property of Furio Intellectual Properties LLC 
MODEL RELEASE FORM    

​Legal Name____________________________________________

Date ______________
 
For valuable consideration as listed below, I hereby give, Tri-Box, LLC and  Sante Furio “ARTIST”, the legal representatives, or assigns, permission to copyright and/or use, publish, and reuse and republish photographic pictures or portraits made of me in which I may be cropped for publication use through print or electronic advertisement (distorted) in form, representing my own name or a fictitious name, through any media and for whatever purpose the photographer chooses.
 
I release and agree to save harmless the Artist, the Artist’s representatives, assigns, acting with the permission of the photographer, including any firm publishing or distributing the finished product, even though the finished product may be distorted, blurred, altered, or used in composite form, either intentionally or otherwise and subject me to public opinion.
 
I waive any right to approve the finished photograph or video or any copy which might be used in conjunction with the finished photograph. I warrant that I am over eighteen years of age, and I am competent to contract in my own name, insofar as the above is concerned.
 
Compensation:  $30.00 per hour. Time will include the photography and or video session with review. 

I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof:
 
Date _______ / _______ / 2021  

Print Name __________________________________________________________

Address ___________________________________________________________

Contact (email or phone number) ________________________________________

Signature __________________________________ 


Tri-Box, LLC • Direct: 847-977-2027 • Office: 847-466-7156 
Email:  [email protected] • www.tri-box.net • www.triboxcarriers.com