FANDOM


Name:

Portal Location:

Portal Destination:

Amount of Time Portal will be Active:

License Expiration Date:


This License Certifies the named individual to create a one-time-use portal from the mentioned location to the other mentioned location. Any portals outside those legally allowed or listed in this License are excluded from these permissions.


Signed,

<Issuer's Name Here>,<Issuer's Title Here>

Community content is available under CC-BY-SA unless otherwise noted.