First Name
Last Name
Street Address
City				State			Zip
E-mail Address			Important to keep this updated!
Business Phone			###-###-####
Fax Number			###-###-####
Years Doing Decompression
Type of decompression table
Chiropractic License Number:

Billing Information

$1499.00 minus $99 credit. Net price is $1399.00 (plus $12.95 shipping)

---

Name On Card
Credit Card #
Expiration Date		MM/YYYY
3 Digit Security Code

Terms, Conditions & Restrictions

---

WSP Advertising reserves the right to suspend or cancel your account. There is no sharing of memberships or programs at all by anyone at any time. We will actively pursue and seek damages any per on or entity that attempts to share any contents reserved for our members. We subscribe to Traffic Facts which gives us data on each visitor/member access, pages viewed, your ISP provider information, bandwidth used, # of page views and when viewed, your operating system, browser and more. In short, we scan for abnormal usage, multiple location access and a host of other information that might indicate you have shared your password information or access. The data is reserved for members only and cannot be accessed with any other person or group. Some data contains "forward looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21B of the Securities Exchange Act of 1934. Any statements that express or involve discussions with respect to predictions, expectations, beliefs, plans, projections, objectives, goals, assumptions or future events or performance are not statements of historical fact and may be "forward looking statements." DO NOT SHARE YOUR PASSWORDS WITH ANYONE. 1. THE LICENSED MATERIALS: The Licensed Materials" consist of: (1) the "Lumbar/Cervical Decompression Spinal Care System", "LCD Spinal Care System", LCD Therapy, and other brand names, together with the "LCD" brands, which are registered and trademarked brands of WSP Advertising; and (2) the Media Kit Package materials supplied by Licensor to Licensee, which are copyrighted materials owned by Licensor. 2. GRANT AND TERM OF LICENSE: Licensor hereby grants to Licensee a non-exclusive license to utilize the Licensed Materials for promoting and advertising Licensee’s LCD Spinal Care System practice and treatment. Licensee may not re-license, re-sell, or make any use of the Licensed Materials except for marketing Licensee’s LCD Spinal Care System practice and treatment as set forth in this Agreement. Licensor retains all trademark and copyright rights in the Licensed Materials. The initial term of the license is one (1) year from the Effective Date. On each anniversary of the Effective Date, this Agreement shall be automatically renewed for successive one (1) year terms, unless either party provides written notice of termination to the other party at least sixty (60) days prior to the next automatic renewal date. Upon termination, Licensee shall return all Licensed Materials to Licensor and shall cease using any Licensed Materials for any purpose. 3. LICENSE FEES: Licensor will pay a Monthly License Fee each month as set forth in Schedule A for so long as this Agreement shall remain in effect. 4. DEFAULTS: If Licensee fails to abide by the obligations of this Agreement including the obligation to make License Fee payments when due, Licensor shall have the option, but not the obligation, to cancel this Agreement by providing fourteen (14) days written notice to Licensee. Licensee shall have the option of preventing the termination of this Agreement by taking corrective action that cures the default within fourteen (14) days after Licensor’s notice of default and termination, or, if the default is one that cannot be cured within fourteen (14) days, by commencing a cure within fourteen (14) days and diligently completing the cure as soon as practicable thereafter. If Licensee fails to cure its default as set forth above, then Licensor’s termination shall become effective and Licensee shall immediately cease to use any of the Licensed Material provided by Licensor. Licensee’s failure to cease in the use of the licensed media may result in an award of punitive damages against Licensee and in favor of Licensor, if warranted under applicable law. 5. ARBITRATION. All disputes under this Agreement that cannot be resolved using good faith efforts shall be submitted to binding arbitration under the rules of the American Arbitration Association with jurisdiction and venue in Humble, TX. The prevailing party shall be entitled to collect its reasonable attorney’s fees and costs associated with the arbitration. 6. WARRANTIES and INDEMNIFICATION. Licensor makes no warranty with respect to the use, sale or other transfer of the Licensed Media by Licensee or by any third party. Client hereby acknowledges that client has been notified the goods or merchandise and the use thereof by client may be subject to the laws of the united states, any state, or any other sovereignty which might prohibit, prevent, or effect the use or proposed use of the goods in such a manner by client, either under the civil or criminal statutes or laws of any such jurisdiction seller makes no representations as to the effect of any such statutes or laws in connection with the goods or clients use or intended use. Client acknowledges that client is free to consult with legal counsel of its own choosing prior to the purchase of any goods and thereafter with respect to the effect of such statutes and laws and clients use or intended use. In no event will Licensor be liable for direct, indirect, special, incidental or consequential damages. Licensee shall indemnify, protect, defend and hold harmless WSP, including affiliated companies, partners, officers, directors, shareholders, employees, agents, successors, assigns, heirs, legal representatives, and devisees for, from and against all liabilities, claims, damages, losses, liens, causes of action, suits, judgments, and expenses (including court costs, attorneys’ fees, and costs of investigation), of any nature, kind, or description of any person, client, customer, or entity, directly or indirectly arising out of, caused by, or resulting from (in whole or in part), (1) Licensee’s use of the Licensed Media, (2) any act, error, or omission after the date of this Agreement by Licensor or anyone directly or indirectly employed by Licensor or anyone that Licensor controls or exercises control over, and (3) any claim or demand by any Customer or Patient. 7. TRANSFER OF RIGHTS. This Agreement shall be binding on and inure to the benefit of any successors of the parties. Neither party shall have the right to assign its interests in this Agreement to any third party without prior written consent of the other party. Consent to transfer shall not be unreasonably withheld. 8. ENTIRE AGREEMENT. This Agreement contains the entire agreement of the parties and there are no other promises or conditions in any other agreement whether oral or written. This Agreement supersedes any prior written or oral agreements between the parties. 9. APPLICABLE LAW. This Agreement shall be governed by the laws of the State of Texas. 10. MEDIA MODIFICATION ACCEPTANCE: By signing below, I confirm that I have read the print media material and have seen and listened to the LCD Spinal Care System infomercial's and commercials as applicable. I understand that there may be third party charges for customization of infomercial's, print or other materials. 11. FAX. Fax signatures and electronic initials are binding. PAYMENT TERM AGREEMENT I authorize the use of an electronic recurring transaction for the monthly license fee installments of $99.00. I understand my installment contract term begins on January 5, 2009 and expires on January 5, 2010 . I further understand that I may cancel anytime after the anniversary date with a written 60-day notice of cancellation. I agree to accept the monthly charges as set forth above and herein. I understand that my credit card will be charged monthly on the anniversary date of this agreement. If my credit card becomes invalid, I authorize the use of an electronic check debit with the checking account number attached hereto. Monthly payments are made in advance of services. I will not pass on this information to any other person at any time. I can use this information for my own benefit only.