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Testimonial Release

Thank you for providing a testimonial statement for Basis. Your comments are very
important to us and we appreciate the opportunity to share them with others.

By clicking I agree I am signing this Testimonials Release, and giving Basis LLC permission to use my first and last name, my photograph and the testimonial statement about Basis services (collectively, the “information”) for marketing and promotional purposes.

Additionally, you agree to the following:

Basis may use the Information on its web site, in print publications and other advertising
and promotional materials and media (the “Publications”).

Basis may disclose the Information to employees and agents working on its behalf to
develop the Publications.

Publications incorporating the Information will remain the property of Basis and there are
no restrictions on the number of times that the Information may be used.

This Testimonial Release will be in effect for so long as Basis uses the Information.

You may revoke this Testimonial Release at any time by sending written notification to
Basis. Your revocation will not apply to prior uses of the Information, but it will prevent
future uses of the Information.

Your refusal to sign this Testimonial Release will not affect your ability to use Basis, or
any other services or products provided by Basis.

Once the Information is disclosed, it will no longer be protected by federal or state
privacy law and may be subject to re-disclosure by others.

You represent that you have the legal authority to release the Information and you
hereby release and discharge Basis from all claims, costs and liabilities arising from its
use of the Information in the Publications.