Review Submission Form for 1 Free Pair


This date must be within 30 days from date of purchase to receive your free pair.
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Upload your 30-60 second review video here. Click browse to select a file on your computer. Please record video in horizontal widescreen mode and not vertical mode when using a cell phone.

You only need to sign this form if you are submitting a video.

I hereby authorize Foot Relief Insoles LLC to:
(a) use my recorded video which contains my personal likeness, photo, and voice on video, audio, photographic, digital, electronic, online format or on any and all other media. (b) Use my name in connection with this recording if my name was included in the recording. (c) Use, reproduce, publish, republish, exhibit, edit, modify, or distribute, in whole or in part, this recording in all media without any additional compensation granted other than one free pair of Foot Relief Insoles Brand Insoles, for any purpose that Foot Relief Insoles LLC deem appropriate, including promotional or advertising efforts. This recording may appear in a variety of formats and media that are now available to Foot Relief Insoles LLC and that may be available in the future (e.g. print publications, video tapes, CD-ROM, Internet, mobile, digital). I hereby release Foot Relief Insoles LLC from liability, claims, compensation claims, and demands for any violation of any personal or proprietary right I may have in connection with such use, including any and all claims for libel, defamation, or invasion of privacy. I understand that all such recordings, in whatever medium, uploaded through this web form are time stamped and include the IP address of the party submitting this form, and are verifiable and directly linked to the person submitting this form by name, address, telephone, digital signature, and order number and that all recordings submitted through this web form shall remain the property of Foot Relief Insoles LLC unless I submit in writing a request to Foot Relief Insoles LLC to remove my recordings and pay the retail price for the free insoles I received. I have read and fully understand the terms of this release.

You only need to check this box and sign below if you are submitting a video review. Otherwise, just hit the submit button below when you are done adding your review link addresses above.