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REPRINT RIGHTS AGREEMENT

DATE: Current Date Order #: Work Order Number Job Job title of signator, authorized signature or signer. Insert the Job Description Here. I, the undersigned, being duly authorized and having the right to grant reproduction rights to Company Name, do hereby request that Company Name reprint the following materials as described below.

In consideration of the agreement by Company Name to reproduce or reprint the materials, I agree to the following terms and conditions. Nothing in the works and materials listed above and/or submitted to Company Name for reprint contains any content that infringes or violates any intellectual property rights of any third party or author. Further, nothing contained within the work or materials or any part or operation of the materials will cause the use, reproduction, resale, or transfer of the rights to the materials to infringe upon the intellectual property rights of any third party.

Nothing in the works and materials will result in the violation of any local, state, federal, international or any other jurisdiction under which the reproduction or reprinting of such materials would constitute an unlawful civil or criminal offense. Company Name has no obligation to review, edit, censor or otherwise certify the materials to ensure they comply with applicable law. I hereby release and discharge Company Name and its agents, representatives and assigns from any and all claims and demands arising out of or in connection with the reprint of the materials, including, without limitation, any and all claims for copyright or trademark violation, invasion of privacy, right of publicity, slander, libel or defamation. I further agree to defend Company Name for all liabilities, damages, judgments, costs or expenses arising out of Company Name being made a part of any claim arising out of the reproduction and reprinting of the materials listed above.

Printed Name:

Job title of signator, authorized signature or signer. Note - all fields are required to be completed.