The following must be initialed and signed in order to receive flammable products. All information is kept confidential. This form protects you, the end user, by keeping pyrotechnics out of the hands of people who may do something inappropriate, thereby giving pyrotechnics a bad name and making it more difficult to purchase for future generations. Thank you for your patience and understanding.

A clear, enlarged photocopy of your drivers license must also be supplied. Agreement must be mailed and received by us before order can processed.

The undersigned hereby acknowledges:

1. That he/she is 21 years of age or older. Initial:______________

2. The chemicals and/or supplies purchased have hazardous properties that may endanger life and limb. Initial:______________

3. That he/she is legally qualified to recieve these materials. Initial:______________

4. That he/she will consult local laws and inform local fire department before using in public. Initial:______________

5. That he/she will not sell or give any items to a third party. Initial:______________

6. That he/she will not send any items out of the country. Initial:______________

7. That he/she will use these items for theatrical purposes only in the state where he/she resides. Initial:______________

8. That he/she is the end user of this product. Initial:______________

9. Pyrotechnics, once purchased, can not be returned for any reason. Initial:______________

10. That he/she will only use pyrotechnic items for commercial use in a professional public display. Initial:______________

11. That he/she will not use pyrotechnics within 20 feet of person under the age of 18. Initial:______________

12. That he/she will not use pyrotechnics within 20 feet of flammable material or objects. Initial:______________

13. That he/she will not use pyrotechnics within 20 feet of members of the general public. Initial:______________

14. That he/she will keep at least two operational fire extinguishers available at all times. Initial:______________

In consideration of the sale of chemicals and/or supplies to the undersigned, the undersigned hereby agrees as follows:

1. The undersigned will not use the chemicals and/or supplies in violation of any local, state or federal law. Initial:______________

2. In no event shall the seller, or seller's heirs and assigns, be liable for consequential damages, nor shall seller's liability on any claim for damages arising out of or connected with the sale, delivery or use of the chemicals and/or supplies exceed the purchase price of the chemicals and/or supplies. Initial:______________

3. There is no warranty that the chemicals and/or supplies are merchantable or that they are fit for a particular use. Initial:______________

4. The undersigned, on behalf of the undersigned, successors and assigns, agrees to hold the seller harmless from and will indemnify seller from damages caused by the use of the chemicals and/or supplies. Initial:______________

5. The undersigned agrees that the conditions above apply equally to all current, past and future purchases from Star Light and Magic:

Signature ________________________________________________________________________________

Date of Birth _______________________

Printed Name ______________________________________________

Today's Date ____________________

I am using this for professional _________________________________________(example: Film, Training etc.).

Address:

Telephone:

Please include an enlarged, clear photocopy of your driver's license.

You must send a copy by mail for our permanent files. All items Must be clearly legible, or we cannot process your order. This form cannot be faxed, however you may send it by overnight express if you are in a hurry.

If these items are being shipped to a third party, we must have an agreement from them as well. Please double-check, all areas must be completely accurate and signed, or agreement is null and void. Pyrotechnics are non-returnable.

All information is kept strictly confidential. Information on this form is viewed by one individual only, then retired to a locked vault, where it is kept under seal. No third parties will ever be granted access to this information.

Mail to:

The Orlando Project
218 Jefferson St.
Lexington, Ky. 40508