AMICO Reproduction Request Form You are requesting a reproduction of the following image: Example Artist Title Accession Number Please fill out as much of the following form as possible: Requester Information: Name Company Full Address Phone - - Fax - - E-mail Medium: Select One 35 mm slide Black and white photograph Black and white print Color print Color transparency Digital file Negative Other (specify) Note: Some Institutions may only offer one type of media for image reproductions. Intended Use and Relevant Information: Check here if request is for study purposes only Publications: Print Media Type Select One Advertising Book Brochure Calendar Exhibition Exhibition Catalog Journal Magazine Poster Product Packaging Other Purpose Select One Commercial Educational Nonprofit Publisher Editor Author Title Edition Print Run (# of copies) Number of Pages Number of Illustrations Image Placement Select One Cover Illustration Full Page Half Page or Less Inside Cover Other Distribution Estimated Price of Publication Expected Date of Publication Electronic Media Type Select One CD-ROM Software Website Other Purpose Select One Commercial Educational Nonprofit Publisher Editor Designer Title or Web Address Edition Print Run (# of copies) Term (# of years) Display Resolution CD Format Select One Hybrid Mac PC Distribution Estimated Price of CD/Software Expected Date of Release Film Media Type Select One A-V Presentation Film Television Video Purpose Select One Commercial Educational Nonprofit Publisher Editor Producer Title Audience Run Period Distribution/ Syndication Estimated Price of Product Expected Date of Release Quantity of Reproduction: Deadline (Date Reproduction Needed By): Return to the Main Reproduction Request Form Page Return to the Rights Committee Page Last modified on May 6, 2002
You are requesting a reproduction of the following image:
Example Artist Title Accession Number
Please fill out as much of the following form as possible:
Name Company Full Address Phone - - Fax - - E-mail
Select One 35 mm slide Black and white photograph Black and white print Color print Color transparency Digital file Negative Other (specify) Note: Some Institutions may only offer one type of media for image reproductions.
Check here if request is for study purposes only
Return to the Main Reproduction Request Form Page
Return to the Rights Committee Page
Last modified on May 6, 2002
