Pulastic Symposium Dealer Case Study Form

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Your Name:*

First Last

Name of Project/Facility:*

Location of Facility:*

City State / Province / Region

Date of Installation:*

Type of Facility:*

Name of System/ Pad Thickness/ Color:*

Contact/ Referral Name:*

First Last

Contact/ Referral Phone #:

Contact/ Referral Email:

Please provide as many details as you can about this project:*

Suggested details include: Why did they choose Pulastic? Was there an issue or past experience that Pulastic solved? What about Pulastic do they like most? Were any repairs done to the surface, if so please explain (with dates)?

How do you use this project in your marketplace to effectively promote and or sell Pulastic?*

How many photos will you be submitting? (Note: you will upload photos on the next page)*

Image Release Agreement:*

On behalf of my company, I hereby grant the absolute rights and unrestricted permission in respect to the video or still imagery of the above referenced project(s) to use, reuse, publish, and republish the same in whole or in part, individually or in any and all media now or hereafter known, and for any purpose whatsoever, for illustration, promotion, art , editorial, advertising, and trade, or any other purpose whatsoever without restriction. I hereby release and discharge from any claims and demands arising out of or in connection with the use of the images, including without limitation any and all claims for libel, or violation of any publicity or privacy. I have read the foregoing and fully understand the contents. This release shall be binding upon me, my employer, legal representatives, and their assigns.

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