Testimonial Release Form - Di Moda European Lingerie

Testimonial Release Form
for Di Moda European Lingerie

First name:

Last name:

Address:

City:

Prov.(State):

Country:

Please identify who you are:

Online customer

Store customer

Testimonial statement:

Through my submit below, I hereby authorize Di Moda to print my testimonial, in full or in
part, and to use in any marketing materials and on their website.

Note: Only First Name, First Initial of Last Name, City and Province (State) will be printed.

The information stated above is accurate and true to the best of my knowledge