Reproduction and Permission to Publish Form - PDF document

Reproduction and Permission to Publish Form Name:Phone: Organization or Agency (if applicable): Address: Email Address: Identifier ( e.g., Collection number, Photo number, Key number, Box and Folder number) and Description Digital, Print, or Re use Resolution or Print Size Qty.Price Ex. MSS 0019813 Alfred C. Finn Collectionfirst filling station 300 dpi 1 12.50 1. 2. 3. 4. 5. * For more than five items, fill outthe Additional Reproduction Requests form. Total Payment must be made at time of order. This form acts as an invoice. Proceeds from reproduction sales go toward the costs of preservation of photographs and archival materials. Orders take approximately 10 business days from the date of payment. NOTICE This institution reserves the right to refuse to accept a copying order, if, in its judgment, fulfillment of the order would involve violation of copyright law. HMRC Staff Use Only Order Taken by: ___________________Date and Time: ____________________Method of Payment: ___________________Delivery Method (circle one):In person pickMailElectronic Delivery Intended UseComplete as applicable. If unknown, please write NEED TO UPDATE so this form can be completed at alater date. Title or Description of Use: Author / Producer: Publisher: Formatcheck all that apply): Book___ Dissertation___ Film/Video ProgramPeriodical___ PresentationSchoolProject/Paper___ Social Media___ Web Content Other (please specify): Conditions of UseAll requests to reproduce the Houston Metropolitan Research Center’s (HMRC) holdings, which may include photographs, architectural drawings, maps, and other documents, must be submitted on this form.Permission for reproduction is limited to the applicantand is nontransferrable and may not be reusedon another projectassigned, or sold without the permission of HMRC.Permission for reproduction is granted only for the express purpose described in this form. HMRC reserves the right to reproduce the image or documentand to allow others permission to reproduce the image or document.Reproductions supplied by the repository may notbe copied, scanned, exhibited, resold, or used for any other purpose than that specified in this application.Audiovisual material may not be reproduced for any reason except that of supplying additional copies for production requirements.Copies shall not be deposited in another library, archive, or repository.Any subsequent use or any change in use from that stated on this form(e.g. subsequent edition)constitutes reuse and must be applied for in writing to HMRC.HMRC reserves the right to refuse reproduction of its holdings if it feels fulfillment of that request would violate copyright or other laws or if the materials are deemed unsuitable for reproduction on account of condition, sensitivity, or privacy concerns. HMRC reserves the right require a release from individuals whose privacy may be violated by the reproduction of an image.It is the responsibility of the applicant to obtain permission to publish from the owner of the copyright (for HMRC, the creator of the record, the author or his/her transferees or heirs).HMRC assumes no responsibility for any royalties or fees claimed by the material’s creator, artist, or photographer, or on their behalf.In all instances, the applicant agrees to holdthe repository and its agents harmless against any and all claims arising or resulting from the use of the material and shall indemnify the repository and its agents for any and all costs and damages arising or resulting from any such unauthorized use.less approved in advance by HMRC, the integrity of the image must be maintained.Files of scanned images delivered electronically must be destroyed once the final product has been produced.The applicant covenants, represents, and warrants that the productwill not contain any feature that would permit users to distort or mutilate the image, nor will the product be intentionally designed or prepared so as to be compatible with any computer program which is designed to manipulate images.The applicant agreesto send HMRC one copy, free of charge, of the work containing the reproduction(s) for inclusion into the HMRC collection at the discretion of HMRC. All expenses for shipping and handling are to be borne by the applicant.All reproductions must include, ina caption, end note, or credit, the name of the repository and the identifier of the item. For example: MSS 12483714, Houston Public Library, HMRC. Credits should appear in close proximity to the image or in a special section devoted to credits in clearly visible and legible type.EndorsementsBy signing this form, I accept personally and on behalf of any organization I represent, the conditions set forth within: Signed Date When signed by an authorized agent of HMRC, this form/invoicconstitutes permission for reproduction as outlinedherein Signed Date Additional ReproductionRequestsForm Name:Date Identifier ( e.g., Collection number, Photo number, Key number, Box and Folder number) and Description Digital, Print, or Reuse Resolution or Print Size Qty.Price Ex. MSS 0019813 Alfred C. Finn Collectionfirst filling stationDigital 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 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