Contact Information

Your full name:

Your email address: (e.g.: you@aol.com)

Address
Company/Organization, Street City, State, Zip Code Country

Telephone

Fax

Are you a current LCP shareholder? (If yes, 10% discount on material fees)

Yes
No

Are you a current LCP Fellow? (If yes, 25% discount on material fees during year of fellowship)

Yes
No

Date of Request

Date Reproduction Needed

Item to be Reproduced

Author or Artist

Book Title (if applicable)

Image Title or Description

Page(s)

Date of item

Accession and/or Call #

Special Instructions for the Photographer

(ie, cropping of text, enlargement of a detail, the position of a book binding, etc.)

Type of Reproduction

Format

Please specify quantity for each format needed
B&W Print: Color Print: 35mm Color Slide Digital File: Transparency Rental: Negative Rental: Microfilm:

Print Size

8 x 10
11 x 14
16 x 20

Special Size

Finish (*add'l 50% materials fee)

Glossy
Matte
Sepia Tone*
Fiber Based Paper*

Digital File specifications required

How will this reproduction be used?

Printed Work *
Exibition
TV/Video/Film
CD-ROM
Internet
Other
Reference Only

*If reproduction will be used for a Printed Work please specify if it will be an internal or external image and if it will fill a full page or less than a full page.

Usage is

Scholarly/Non-Profit
Commercial

Author of Printed Work

Title of Printed Work

Publisher of Printed Work

Print Run