Testimonial Form

Please consider providing a personal testimonial regarding your experience at Wolverine Orthotics, Inc.

For good and valuable consideration, the receipt of which is hereby acknowledged, I, the undersigned hereby give Wolverine Orthotics, Inc., its subsidiaries and affiliates, successors and assigns and all parties acting under their permission (hereinafter " Wolverine Orthotics, Inc."), my full and unqualified consent to copyright, use and publish for any and all commercial purposes whatsoever my statement(s) and/or my image as set forth below or otherwise captured in any form or medium (i.e. electronic, video, audio, etc) or a reasonable restatement thereof, concerning the service(s) or product(s) of Wolverine Orthotics, Inc., either in conjunction with or without using my name. I further agree to hereby waive all rights to approve the form of any advertising, and understand that Wolverine Orthotics, Inc. has no obligation to use my statement(s), image, and/or my name in any advertising. I represent that all information which I have provided to Wolverine Orthotics, Inc. is true and accurate.




Wolverine Orthotics, Inc.
28455 Haggerty Road, Suite 101 | Novi, MI 48377
Phone: (248) 324-3010 | Fax: (248) 324-3003

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