IN ORDER TO RECEIVE ITEMS PURCHASED FROM Z11 PYRO SUPPLY, YOU MUST READ, PRINT OUT, FILL OUT, AND SIGN THIS FORM.
PLEASE INCLUDE A PHOTO COPY OF YOUR DRIVER’S LICENSE OR STATE ID TO VALIDATE

HOLD HARMLESS AGREEMENT:

By signing below, I certify that:

I am 18 years of age or older, and may be required to be at least 21 or order to use these products in some areas.

I understand that the chemicals and/or supplies purchased may have hazardous properties that can endanger life and limb; as well as personal or public property.

I will read and follow all directions provided with the items I receive, and use them only for their intended, theatrical purposes..

I understand that it is my responsibility to learn about and obtain the proper, permit(s) and/or licensing, and insurance that may be required for use of these products in my area of use, or as federally required. I acknowledge that an ATF License is required when using binary flash powder for business purposes. Also, unused remaining flash powder must either be disposed of as instructed, or stored in an approved magazine.

I understand that there are no guarantees that the chemicals and/or supplies purchased will suite a particular purpose.

I understand that custody of all products is released from Z11 Pyro Supply to me once said products are in my possession.

I understand that in no event shall Z11 Pyro Supply, Zack Percell, or any persons affiliated with Z11 Pyro Supply be liable for consequential damages, nor shall liability on any claim for damages arising out of or be connected with the sale, delivery, use or misuse of any chemicals and/or supplies purchased from Z11 Pyro Supply.

I, my successors and assigns, agree to hold Z11 Pyro Supply, and all persons affiliated in any way with Z11 Pyro Supply harmless from and will indemnify seller from damages caused by the use or misuse of the chemicals and/or supplies purchased, or otherwise obtained. Use includes, but is not limited to use by myself or by any person(s) obtaining said products from me in any way.

I agree to be considered liable for any and all damages that may occur during the use or misuse of any products purchased from Z11 Pyro Supply.

I agree that the conditions above apply equally to all past, current, and future purchases from Z11 Pyro Supply.

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Z11 PYRO SUPPLY

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THANK YOU! IT IS REQUIRED THAT THIS FORM BE ON FILE WITH US BEFORE OBTAINING CERTAIN PRODUCTS.