AMICO Rights Committee
Common Reproduction Request Form
Comparison of On-Line Forms in Use
AMICO Member (by abbreviation): Requestor Information:
Name Institution/Company/Organization Full Address Phone Number Fax Number Email Address Date Delivery Mode Staff Contacts Requestor Status: Not-for-profit Organization For-profit Company Individual Nature of Publication: Commercial Non-commercial Editorial Advertising Educational Artist Civilization/Country of Origin (of work) Title Date Medium Accession Number Photocopy Dimensions Photograph Transparency 35 mm Slide Digital Image Research Print Negative Web CD-ROM Film/Video Display/Exhibition Printed Publication Information: Author Title Intended Date of Publication Print Run Language(s) Distribution Quantity of Insertions Size of Image Publisher Retail Price Run Period Audience Distribution Purpose Distribution Display Resolution CD Format Edition Term Copy Protection Against Method of Copy Protection File Receipt Name Title Expected Date of Release Editor Publisher Duration License (single or multiple editions) Print Size Quantity of Print Deadline (Date by which materials are needed) Placement (of Image to Page) From Websites From Forms sent via Fax
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Last modified on October 23, 2002
