Share Your Story

Submitting your comments and image(s) using this form will give us permission to publish your name, likeness, city, state and story on our website, in Verilux catalogs or in any other Verilux, Inc. promotional materials without compensation. Please be as specific as possible about what you have liked regarding your Verilux purchase, including how it has made a meaningful difference for you.


First Name:	*	Last Name:	*
Email:	*	Telephone:
Address:		City:	*
State / Province:	*	Zip / Postal Code:

Product Name:

Please add your comments on the selected product. Be as detailed as possible so other customers can get a sense of how it affects you and your life.

Please add a photo of yourself for use with your testimonial. JPG files under 500k are recommended.
File:

Yes! Please add my testimonial. By selecting yes, you agree to the terms of the legal release below.
Legal Release: By Submitting your comments and image(s) through this form the user agrees that Verilux, Inc. has complete ownership of such pictures, stories, etc., including the entire copyright and rights to modify as required to clarify provided information, and may use them for any purpose. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. User acknowledges that you will not receive any compensation, etc for the use of such pictures, etc., and hereby release Verilux, Inc. and its agents and assigns from any and all claims which arise out of or are in any way connected with such use.
Yes, I would like to receive special email promotions & discounts from Verilux.

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