TESTIMONIAL RELEASE AND WAIVER FORM

I,___________________________________, hereby agree as follows:

1. I hereby irrevocably grant to Dollars Your Way™, LLC, its parents, subsidiaries, affiliates, successors and assigns (collectively, "Company"), for good and valuable consideration, receipt of which is hereby acknowledged, the right to use the testimonial of a true experience that I had using the product (the "Testimonial"), any and all photographs, images, illustrations and/or videos made available to Company by me (collectively, the "Images"), as well as my name and any biographical material ("Bio" and together with the Testimonial and Images, the "Content") in any and all forms of marketing and promotional material including, without limitation, print advertisements ("ads"), online ads, television ads, radio ads, interactive media, as well as printed extracts and reproductions of any portion thereof, and for any and all other uses.

2. I hereby irrevocably give and grant to Company the perpetual worldwide rights to use and reuse, publish and copyright my Content in all media and types of advertising and promotion of Company and its products and services. I represent and warrant that: (a) I have all of the rights and authority necessary to submit the Content for the uses contemplated hereunder, including the right to publish the Content; and (b) the publication of the Content will not infringe on the rights of any third party. Nothing herein will constitute any obligation on behalf of Company to make any use of any of the rights set forth herein.

3. I hereby certify to Company that everything I revealed about the Content is true and an expression of my personal belief. I acknowledge and agree that at no time did Company provide any consultation, advice or guidance with respect to the substance of the Content. I am not: (a) an employee, officer or director of Company; (b) an immediate family member of an employee, officer or director of Company; nor (c) living in the same household with an employee, officer or director of Company.

4. I agree and understand that the aforesaid Content, in whole or in part, may be edited and/or dramatized, and that any part of the aforesaid Content may be used without compensation. I agree that no advertisement or other material incorporating or making reference to the Content need be submitted to me for approval and Company shall be without liability to me whatsoever for any distortion or illusionary effect resulting from its publication of the Content.

5. I expressly release Company from and against any and all claims that I have or may have for invasion of privacy, defamation, copyright infringement or any other claim or cause of action arising out of or in connection with the production, distribution, duplication, broadcast, exhibition, publication, advertisement, promotion or any other use of the Content. I acknowledge and agree that Company shall not be liable for any causes of action or claims related to my decision to provide the Content to Company.

6. I warrant that I have read the Testimonial Release And Waiver Form prior to signing, and that I am fully familiar with the contents and consequences of same. I certify that I am over eighteen (18) years of age.

Signature: _______________________________ Date: ________________

Name (please print): __________________________________________________

Address: _____________________________________________________________

City: ___________________________ State: ___________

Zip: _________________

Telephone: ______________________ E-Mail: _____________________________