I _________________________________ (Photographer) authorize Pop Art Pet, LLC. to make an electronic image of the photograph(s) described below. I understand that Pop Art Pet, LLC. will use this image to create one or more “digital portrait(s)” by electronically altering the pixels in the original photograph(s) and printing the completed works 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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^{(Photographer’s name, please print)}


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^{(Customer Name)}


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^{(Photographers Signature)}


Business Name & Address___________________________

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Phone No. (______) _____________________

Pop Art Pet, LLC. -- 12902 E Idaho Drive, Aurora, CO 80112 – (720) 488-3575