University of Washington Libraries

Manuscripts, Special Collections, University Archives Division (MSCUA)

Allen Library, Box 352900, Seattle, WA 98195-2900

(206) 543-1929 fax (206) 543-1931 Email:

Reproduction Request Application and Agreement

This form must be completed and signed before the reproduction order can be processed.

By signing this form I understand and agree that:

  1. The University of Washington Libraries retains all rights to the reproductions, including the right to grant others permission to reproduce the photographs.
  1. The reproduction is provided for reference use only and may not be sold or duplicated for sale. It will not be given to other institutions, businesses, or private entities that provide photographs for the public.
  1. I will not copy the requested reproduction/s in any form and by any means nor will I allow others to do so.
  1. I will not publish, display, reproduce, or broadcast this material in any format without first obtaining written permission from the University of Washington Libraries. An Application for Permission form must be signed and returned to MSCUA in order to obtain a Letter of Permission before this image/s can be published or broadcast in any medium. I understand that permission for reproduction may be refused in cases of donor restriction and copyright law violation.
  1. I assume all responsibility for questions of copyright or literary rights that might arise.
  1. I agree to pay all charges that may be incurred with this request (including rush fees, shipping costs and the production of copy negatives that remain the property of MSCUA).
  1. I agree to pay all usage fees that may be incurred when permission has been granted to publish or broadcast this material.

I have read and agree to the above conditions. I understand that failure to comply with these rules may result in the denial of future requests for reproductions.

______

Print: Name/Phone Number Agency/Institution

______

Signature Date

3/3/03

Reproduction Request: UW Libraries, Manuscripts, Special Collections, University Archives (MSCUA)

PLEASE PRINT

Name:______Date Ordered______

Company/Institution______

Address______

Phone ______Fax ______Email ______

Mail Pickup Fed Ex ______UW Budget name/number______

(Please do not pre-pay for order)

Normal turn around time for orders is 10 days.
Description/negative number / Qty / Photo
Print size / Slide /

Digital

Scan*

/ Arch Draw
Paper/ Vellum**

Note: all prints orders are glossy unless otherwise specified. **Note: a $25 courier fee may apply.

Special Instructions______

Digital Files*

Operating system: __Mac __PC File Name:______

DPI: __72 __300 __600 _____other Format: __TIFF __PICT __JPEG __GIF __other

Output: __Floppy __Zip __Optical/Mac __CDRom/PC-Mac __Syquest/Mac ____Email

Order taken by______3/3/03