Application for the issue and authorisation of video reproductions for commercial purposes

Name *

Surname *

Address

Street address

Postal Code

City/Town

Country

Tel./Phone *

Email *

having read and accepted the Regulations, ask

For itself

On behalf of

Release of video reproductions held by the VIVE

Authorisation to use VIVE video reproductions commercial purposes

Authorisation to use, for commercial purposes, video reproductions made by the applicant or already held by his/her

Authorisation to make and use, for commercial purposes, video reproductions outside the VIVE sites

of the following site (s):

and the authorisation for use for the following reasons:

Reason

In the following places:

1 Country

Worldwide

and authorizes VIVE to use these personal data exclusively for the purpose of processing this application.