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RELEASE FORM

AGREEMENT FOR PURCHASE AND AQION RELEASE FROM LIABILITY
PROFESSIONAL/COMMERCIAL USERS

As a professional/commercial user “User”, I certify that the signed User below is not a retail consumer and has the knowledge and expertise to properly utilize these therapeutic products without input from Aqion, LLC and its dba Aquacura and any other related entities “Seller”. Given the User’s confirmed level of expertise, User releases Seller, employees and agents from any liability arising from the use or mis-use of purchased products.


User certifies that the therapeutic remedy or remedies “Products” that are under US government supervision/regulations and purchased now and in the future from Seller will be used only for non-food fish (or other non-food aquatic species) use. User may NOT resell these products without the express written consent of Seller (see separate resale agreement).  Note: “non-food” in this agreement refers to aquatic species not cultivated for human consumption or cultivated for consumption by aquatic species that will be in turn consumed by humans. 


Furthermore, User certifies Products purchased from Seller will be not used, provided for use, or resold for use in human medical situations or for veterinarian use with animals under US governmental regulation or for fish or other aquatic life (including their eggs and young) destined for human consumption or for use in a country or legal jurisdiction in which covered products are prohibited. 


Lastly, this is a legal document confirming that the below signed entity releases Seller from liability if User violates any of the agreed prohibitions in this document. Any User violation can result in the suspension of purchases and possible reporting to appropriate authorities, by the Seller. 

Forms that are incomplete will be rejected. Shipment of products will not commence until a fully executed form is confirmed on file.

Dated: May 18, 2024

First User's Name

First Name*

Last Name*
First User's Age Acknowledgment*
First User's Date of Birth*
I certify that I am 18 years of age or older
First User's Information

Company Name
First User's Signature*
Second User's Name

First Name*

Last Name*
Second User's Date of Birth*
Second User's Information

Company Name
Third User's Name

First Name*

Last Name*
Third User's Date of Birth*
Third User's Information

Company Name
Fourth User's Name

First Name*

Last Name*
Fourth User's Date of Birth*
Fourth User's Information

Company Name
Fifth User's Name

First Name*

Last Name*
Fifth User's Date of Birth*
Fifth User's Information

Company Name
Sixth User's Name

First Name*

Last Name*
Sixth User's Date of Birth*
Sixth User's Information

Company Name
Seventh User's Name

First Name*

Last Name*
Seventh User's Date of Birth*
Seventh User's Information

Company Name
Eighth User's Name

First Name*

Last Name*
Eighth User's Date of Birth*
Eighth User's Information

Company Name
Ninth User's Name

First Name*

Last Name*
Ninth User's Date of Birth*
Ninth User's Information

Company Name
Tenth User's Name

First Name*

Last Name*
Tenth User's Date of Birth*
Tenth User's Information

Company Name
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Company Name
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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