I, _________________________________ (Copyright holder) authorize Airtoons.com to make an electronic image of the photograph(s) described below. I understand that Airtoons.com will use this image as a reference to create one or more “digital portrait(s)” using a computer and optionally printing the completed work(s) on art media.

Photograph(s) Description:
^{(For example, name of the event or subjects, date taken, ID or negative number, etc.)}

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Authorization


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^{(Copyright holder’s name, please print)}


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^{(Airtoons.com Customer Name)}


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^{(Copyright Holder's Signature)}


Business Name & Address __________________________________

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Phone No. ( ______ ) _____________________

Date ____________________

Please fax to Airtoons.com: +1 (502) 371-7351 or scan and email this form. For further assistance please contact the Airtoons pilot!