AUTHORIZATION LETTER I, ______________________________________________________(firstname and surname) (*) born in:________________________________________________________________(nation) (*) year of birth:______________________________________ (*) e-mail address:_________________________________________________________________ (*) personal http web site:_________________________________________________________ (*) resident in:_______________________________________________________________(address) city:____________________________________________________________________ nation:__________________________________________________________________ phone:___________________________________________________________________ author and owner of the paintings listed below, authorize www.imagobox.com to expose these paintings into the site www.imagobox.com and authorize www.imagobox.com to show the author's informations marked by the symbol (*) into the personal card of the author into www.imagobox.com . I authorize the use of my personal informations only for the publication procedure on www.imagobox.com . I reserve me the right to stop the publication by sending to imagobox via normal mail an interrupting request. After the receiving of the stop request, the publication will be removed within 15 days. work number 1 title:___________________________________________________________________________ year of realization:_________ technique:_______________________________________________________________________ dimensions (cm):_____________________________ work number 2 title:___________________________________________________________________________ year of realization:_________ technique:_______________________________________________________________________ dimensions (cm):_____________________________ work number 3 title:___________________________________________________________________________ year of realization:_________ technique:_______________________________________________________________________ dimensions (cm):_____________________________ NATION:______________________ CITY:___________________________ DATE:_____________ SIGN_____________________________________________________________________________