Peptide Purchase Survery & Liability Waiver Peptide Purchase Survey & Liability Waiver For Research-Use Only Products Company Name Website Effective Date * Section 1: Customer Information Full Name * Email Address * Phone Number (optional) Shipping Address * Section 2: Research Intent Survey Laboratory research Animal testing Educational demonstration Other (optional) These products are NOT for human consumption? * Yes No Peptides are not approved by the FDA? * Yes No Have you read the product safety & storage guidelines? * Yes No Section 3: Legal Acknowledgment * I am at least 21 years of age. I understand peptides are for research purposes only — not for human or veterinary use. I will not resell or redistribute these products in violation of any laws. I assume full responsibility for safe storage and usage. I understand misuse may result in permanent account termination. Section 4: Release of Liability By submitting this form, I release and hold harmless The Wellness Culture, its owners, affiliates, and suppliers from claims arising from misuse/mishandling of peptides, violation of laws/regulations, or adverse outcomes during research. Section 5: Certification & Signature Signature * Clear Signature Sign with your mouse or finger (on mobile). Signature is required. Signature Date * I certify that the information provided is truthful and that I have read, understood, and agree to this waiver. * Do not fill this out: Submit Waiver
