>> home : image library : orders : order form / letter of agreement
|
>> home : image library : orders : order form / letter of agreement
|
Film Footage Letter of Agreement (You must also complete the Invoice)Requestor: To order preview or broadcast quality copies of film footage from the RMS-Republic.com's collections, complete this "Letter of Agreement" and the "Order Form/Invoice," sign at the bottom, and return both pages along with the proper payment to RMS-Republic.com. A photocopy of this order form will be sent to you with your order; the original will be retained on file at RMS-Republic.com.
Section A:
For Office Use Only: Ref # _____________________________
Staff ______________________________
Special Instructions/Conditions: ________________________________________
Section B:
Requestor, Please Fill Out As Completely As Possible:
Today's Date: ________________ Date Needed By: _______________________
Requestor: _____________________________________________________________
Affiliation: ___________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: (____) ______________________________________
E-mail: ___________________________________________
Footage to be Used For (Circle One and Describe Below):
Digital Publication Display | Exhibit Film | Video Presentation
Lecture Commercial Product Advertising | PromotionalDescription of Use:
____________________________________________________
Method of Delivery: ____To be picked up ____To be mailed U.S. First Class Mail
Ship Via____________________ Account #________________________________The CONDITIONS of this form are approved and agreed to by:
Requestor's Signature: __________________________________________________
Requestor's Name and Title: ________________________________ Date: ______________
Use Authorized by:_________________________________ Date: ______________
Access Services Representative