COPYRIGHT REQUEST FORM
First Name
Last Name
Organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Area Code
Phone Number
example@example.com
Object Information:
(title, dimensions, date, negative number)
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Request Type:
Study Purposes Only
Reproduction Purposes
For reproduction requests, please complete the following information relevant to your proposed use:
Media:
Title:
Author:
Publisher / Outlet:
Publication Date:
Type a question
Interior
Cover
Territory & Language:
Size on Page:
1/16 of page
1/8 of page
1/4 of page
1/2 of page
Full Page
Two Page Spread
Print Run / Duration:
Date of Request:
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Month
-
Day
Year
Date
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