Photographic Services

 

REPRODUCTION APPLICATION

Name of Applicant:
Organization:
Address:
 

 
I wish to use _____ total  image(s) received from INA
for reproduction in color ______ and/or black & white ______.
Catalogue number or description of @ image:

 

 

 

 
For Publication in:
  • Non-Profit Publication ______
  • Commercial Publication ______
  • Other, please specify:
Author:
Title:
Publisher:
Expected publication date:
Publication rights requested for:
  • One Country       ______
  • Global                ______
  • Personal use only     ______
When this form is returned to INA, you will receive an invoice for the applicable fees and a written permission to reproduce the image(s). Reproduction permission is contingent upon payment of fees and assurance that two copies of the product in which the image(s) is used will be sent to INA without charge (if a book, one copy will suffice).

Date:

Name and Signature