(Related forms note: use Form SW-4 Photograph Duplication Request Form for reproducing photographs; use Form SW-18 Photoduplication Request Form when the Center's staff makes photocopies for a user.)

Person/ Organization (hereinafter, "Copier") requesting the Center of Southwest Studies' Permission to reproduce materials in the Center of Southwest Studies Special Collections:

NAME(s) _________________________________________________________________________________

ADDRESS ________________________________________________________________________________
                    (Street or P.O. Box)                                          (City)                       (State)            (Zip)

PHONE (______) ______ __________

Accession number(s) of the Center's material to be reproduced: ____________________

DESCRIPTION OF MATERIALS BEING REPRODUCED:

INFORMATION CONCERNING THE COPIER AND PURPOSE OF THE COPYING:

This agreement gives the Copier permission to reproduce the above described materials for the above stated use.  Such reproduction may be in the form of photocopying, photoduplication, microfilming, digitization, or other form that faithfully reproduces the Materials.   The Center of Southwest Studies retains all rights of copyright that it holds in the materials being reproduced by or for the Copier.

Copier's signature _______________________________________     Date_______________

Copier's title (if agent for organization) _____________________________________________

Approved by ____________________ for Center of Southwest Studies     Date_______________

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