WADE - Photo Loan Request Form

Photo Loan Request Form

Marion E. Wade Center, Wheaton College, Wheaton, IL
Contact Information
Name of Requester*

First NameLast Name
Address of Requester or Publisher

Company Name

Street Address

CityState / Province

Postal / Zip Code
Country (if outside of the US)
Email*
example@example.com
Phone Number

Area CodePhone Number
Name and title of the person SIGNING the loan agreement
Type of Use
Would you classify this use as Academic or Commercial?*
Type of Use or Publication
Type of Use (Other)
Will image(s) be used on the cover or interior of the publication?
Publication Information
Title of Publication (if applicable)
Author or Translator of Publication (if applicable)
Name of Publisher / Distributor (if applicable)
Notes about needed image format or size
URL(s) where image(s) will appear (if applicable)
Projected date of publication or broadcast, or usage date range
Area of distribution, and / or number of copies (print run)
Approximate length of publication (in pages, words, or time)
Did you see an image somewhere you have in mind for use? If so, where?
If you have specific images in mind, provide samples of them as attachments

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