Digital Images, Media and Licensing Order Form

Contact Information:

Name:
Address:
City:	State:   Zip:
Country:
Phone:	Fax:
Email:
Tax Exempt ID:

Order Information:

Image, other media to be used for Fair Use purposes only Yes
No

Date of Request:   

Date Needed By:   

Format Types (Please select all that apply) 300 dpi Digital Image file
600 dpi Digital Image file
.JPG file format
.TIF file format
Digital Audio file on CD
Digital Video file on DVD

WSHS Member Yes
No

Non-Profit Organization Yes
No

Use of images, media content - Other - please describe
(If the image or other media is for Editorial or Commercial use (i.e. not Fair Use)
please refer to list on Image Duplication & Licensing page):

Order Delivery Mail
Pick Up
FTP (images are available for 14 days to download)

Description of Image request:
Image Catalog Identification number(s); title(s); other descriptive information – please use a semi-colon or backslash (/) character to separate image descriptions:

Please refer to our Image Use and Policy Page for terms and conditions which apply to this order. Once you have selected the submit order button below, you will be contacted by a WSHS staff member to complete a licensing agreement and payment processing for completion of the order.

For questions about placing an online image order, please email: Washington State History Research Center