Company Name (recommended)

First Name Last Name

Address Line 1

Address Line 2

City AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SD TN TX UT VA VI VT WA WI WV WY State Zip Code

Country (if other than USA)

Email Address (required)

Contact Phone No. (recommended)

Contact Fax No. (recommended)

Image / Usage Information:

Image name, or type of photo you are looking for:

Advertising - Print Media Advertising - Television Advertising - Other Album, CD, CDROM cover Annual Report Billboard Brochure, Catalog, Direct Mail Calendar - Retail Corporate Editorial Credit / Phone card Logo - Large Company Logo - Small Office Magazine - Editorial Newspaper - Editorial Packaging Picture Book Poster - Educational Poster - Consumer Retail Poster - Retail Educational Promotional Materials Public Display - Commercial Slide Show - Commercial Text book, Encyclopedia Web - Commercial (specify hits/year) Other (see notes) Usage

N/A 1/4 Page or less 1/2 page 3/4 page Full Page Cover (less than 1/2 page) Cover (1/2 page or more) Back Cover 2 Page or Wrap Cover Other (please specifiy) Size Color, B/W

N/A 4,999 or less 5,000 - 19,999 20,000 - 49,999 50,000 - 99,999 100,000 - 249,999 250,000 - 499,999 500,000 - 999,999 1,000,000 - 2,999,999 3,000,000 or over (specify) Circulation or Print Run

Type of use Commercial, Commercial - Internal use, Non-commercial (specify)

Distribution: International, National, Regional, Local

Exclusive Rights: International, National, Regional, Local, None
(Exclusive Rights will increase the price of the license)

Company Size, number of employees:
1, 2-4, 5-10, 11-50, 51-100, Over 100

NOTES:
Please describe any other details regarding how the image will be used, and explain any factors that may effect your choices above. You can also include information such as; your deadline, secondary uses, multiple specified uses, narrative etc. You may also send a separate Email message to describe your usage if you wish.

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