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| Your Name |
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| Company Name |
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| Billing Address |
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ORDER INFORMATION (Available from your "Account" area at www.jupiterimages.com)
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| Order Number |
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| Date of Purchase |
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| Billing Address |
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| PRODUCTS PURCHASED |
| Image #'s |
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| Circle one: |
| 600kb |
1mb |
10mb |
28mb |
56mb |
72mb |
129mb |
other |
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| REASON FOR RETURN OF PRODUCT (Required) |
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I understand that by accepting a refund for the item(s) listed above, I am confirming the following:
I and my employer are relinquishing all rights to possession and/or use of any of the single images listed above and/or all the images listed above;
We are confirming we have deleted and/or otherwise destroyed any and all copies of the image(s) that we might have downloaded or made, be they electronic
copies, printed copies, or copies of any other kind in any medium whatsoever; We further confirm that we have not conveyed copies of the image(s) to
anyone else; We also acknowledge our understanding that should we retain and/or use and/or permit anybody else to use any of the image(s), we are in direct
and willful violation of JupiterImage’s copyright(s) and we are therefore liable for actual or statutory damages as well as punitive damages.
I confirm that I am authorized to agree to these terms and sign below.
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| AUTHORIZED SIGNATURE: |
__________________________________ |
DATE: |
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| PRINT NAME: |
__________________________________ |
PHONE: |
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| FAX COMPLETED FORM TO: 520-881-1841 |
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JUPITERIMAGES
/ 5232 E. PIMA ST., STE. 200C
/ TUCSON, AZ 85712
/ 520-881-8101
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