Photographic Services Order Form

Please complete one form for each different object.

Identification Details

Object’s Inventory number (five digit number):

Description:

If there is more that one image of the object available, please insert the URL of the image that you want (from the museum collections pages):

If above details are unknown please list source or other identifying information:

Type of Media Requested

 Digital image on CD-ROM Digital image via web transfer A4 colour print (inkjet)

Type of Permission Rights Required

Type of publication:
 Printed publication Electronic publication Inside publication Television academic Cover uses Other uses, inc. advertising

Distribution:
 Single country World one language World multi-language

Full details of publication in which photograph will appear:

Production run:

Applicant’s Details

Your Name (required)

Your Institution/Department if applicable

Your Address(required)

Your Email address (required):

Billing Details

 Same address

Party to be billed (required)

VAT No.:

Email:

 Agreement In submitting this form I agree to the terms and conditions governing the Museum's photographic services.