Name of applicant:____________________________________________
Organization or agency (if appropriate):______________________
City, State, Zip:_____________________________________________
Phone: _________________________ Fax:_________________________
__ These materials will be reproduced. (Please attach a description of the project, if available.)
Title or description of use: __________________________________
Projected date of publication: ________________________________
Format: _ Book _ Magazine _ Film/Video program _ Advertisement _ CD-ROM/multimedia
_ School project/paper _ Other: ____________________________
Estimated size of edition (number of copies/size of market):__
Call number | Artist or Collection | Title or Description
______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________
Permission for reproduction is granted only when this application is countersigned by a representative of [Repository Name]. Permission for reproduction is limited to the applicant and is non-transferable.
Permission for reproduction is granted only for the expressed purpose described in this application. This permission is non-exclusive; [Repository Name] reserves the right to reproduce the image and to allow others to reproduce the image.
Any subsequent use (including subsequent editions, paperback editions, foreign language editions, etc.) constitutes reuse and must be applied for in writing to [Repository Name]. Any change in use from that stated on the application (e.g., increased size of edition, change in market) requires permission of [Repository Name]. An additional fee may be charged for reuse or change in use.
In the event the applicant engages in unauthorized reproduction of the materials, the applicant agrees to pay [Repository Name] a sum equal to three times the normal commercial use fee, not as a penalty but as liquidated damages agreed upon due to the difficulty in assessing actual damages incurred; [Repository Name] may in the event of unauthorized reproduction require surrender of all materials containing such unauthorized reproductions, and the applicant agrees that such materials shall be immediately surrendered upon receipt of request from [Repository Name].
[Repository Name] reserves the right to refuse reproduction of its holdings if it feels fulfillment of that order would be in violation of copyright law or other law. [Repository Name] reserves the right to refuse reproduction of its holdings and to impose such conditions as it may deem advisable in its sole and absolute discretion in the best interests of [Repository Name].
[Repository Name] will not accept orders for nor allow photocopying (i.e., Xeroxing) or scanning of original photographs.
Copyright: In cases of works by living artists or and/or subject to the 1976 Copyright Law or the 1991 Visual Artists Rights Act, written permission must be secured by the applicant from the artist, his/her agent, or the copyright owner and provided to [Repository Name] before a photograph of the artwork will be released.
WARNING CONCERNING COPYRIGHT RESTRICTIONS:
The copyright law of the United States (Title 17, USC) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, archives and libraries are authorized to furnish a photocopy or reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copyright infringement. This institution reserves the right to refuse a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law.
Privacy: An individual depicted in a reproduction has privacy rights as outlined in Title 45 CFR Section 46 ("Protection of Human Subjects"). [Repository Name] reserves the right to require a release from individuals whose privacy may be violated by the publication of this image.
[Repository Name] extends the rights of privacy to include ceremonial objects and rites of cultural groups and requires the permission of that group before releasing reproductions. [Repository Name] requires the permission of a the group if images of that group will be used in a religious context.
Owner of original: In instances where [Repository Name] holds only a reproduction, the written permission of the owner of the original is required.
It is the responsibility of the applicant to obtain permission to publish reproductions from the owner of copyright (the institution, the creator of the record, the author, or his/her transferees, heirs, legatees, or literary executors). [Repository Name] will aid the applicant in contacting individuals pertaining by providing addresses, when available. However, [Repository Name] does not warranty the accuracy of that information, and shall not be responsible for any inaccurate information.
In instances where the individual or organization who may grant permission cannot be contacted, [Repository Name] may consider granting permission for reproduction based on the applicant's evidence of a good faith effort to obtain contact with the appropriate individual. However, [Repository Name] assumes no responsibility for infraction of copyright laws, invasion of privacy, or any other improper or illegal use that may arise from reproduction of any image.
In all instances, the applicant agrees to hold [Repository Name] and its agents harmless against any and all claims arising or resulting from the use of this image and shall indemnify [Repository Name] and its agents for any and all costs and damages arising or resulting from any such unauthorized use.
Payment of a commercial use fee does not exempt the user from the credit line requirement. Failure to include a credit line or electronic watermark, or inaccurate captions or credits shall require the applicant to pay $100 per image as liquidated damages and not as a penalty in view of the difficulty of assessing actual damages for this breach.
In addition to the rental fee, a charge equal to the replacement costs will be assessed for any materials not returned within 10 weeks or in damaged condition.
Applicants may be granted permission to retain reproductions or other imagery supplied by [Repository Name] for personal or educational use. If such permission is granted (see Section 9 of this form), reproductions may not be copied, scanned, exhibited, resold, or used for any other purpose than that specified in this application. Copies shall not be deposited in another library, archive, or repository without the permission of [Repository Name].
[Repository Name] reserves the right to examine proofs and captions for accuracy and sensitivity prior to publication with the right to revise if necessary. [Repository Name] reserves the right to refuse any request and to impose such conditions as it may deem advisable in the best interests of [Repository Name].
If permission is granted to distribute an electronic copy of an image, the distributed copy shall not exceed a display or print resolution of greater than VGA screen resolution (72 dots per inch or 640x480 pixels).
If the size of edition or number of editions exceeds the terms specified in this application, the applicant shall immediately pay the difference in use fees. If payment is not received within thirty days, the applicant agrees to pay a use fee equal to twice the originally quoted use fee.
By signing this application, I accept personally and on behalf of any organization I represent the conditions set forth above. Signed:______________________ Dated: _________________________
When signed by an authorized agent of [Repository Name], this form constitutes permission for reproduction as outlined in this application.
Signed:________________________ Dated: _________________________