USER INFORMATION

Name ______________________________________________   Phone # __________________

Email address __________________________________________________________________

Mailing address ________________________________________________________________

Title, and institutional affiliation ___________________________________________________

CONDITIONS OF USE  
(Please save a copy of this form so you will know the commitments you have made.)

In consideration of the Center's supplying you ("the user") with a copy of an image, the user agrees:

1.  to accept responsibility regarding questions of copyright and/or invasion of privacy that may arise in the use of this material, and

2.  to use the image only once and then only for the purpose stated on this form (any subsequent use of an image requires the written permission of the Center and the payment of additional fees prior to any use; the Center does not allow its images to be used out of context or modified in any way that affects the historical integrity of the image), and not to authorize others to use the image(s) for any reason, and

3.  to credit each individual reproduction to the Center of Southwest Studies.  Proper credit must also be given to the creator if known.  The preferred citation is as follows: Used by permission of Fort Lewis College, Center of Southwest Studies, [collection title], [creator's name, if known],[call number or image file number].

The Center hereby requests, and is appreciative of receiving, a free copy of any publication or production using image(s) reproduced from the Center's collections.

Fees are in 3 categories: reproduction processing, use, and handling/shipping:

1.  REPRODUCTION/ PROCESSING FEES  No exceptions.  Please circle the fee/s that pertain to this request.

2.  USE FEES       Per image, per use, per edition.             Please mark the appropriate category.
These fees are in addition to reproduction, handling, and mailing fees.

Use fee discounts:

• The Center charges no use fee for images solely used for personal research or display in a private home.
• The Center charges no use fee for images solely used by any Colorado not-for-profit* or government agency; by university presses engaging in non-commercial publication; and by Colorado news media publishing newspaper articles, newscasts, or non-commercial documentaries.
• Non-profit organizations outside Colorado* are eligible for a 50% discount on category B-E use fees. 
                                         *The Center requires written proof of non-profit status prior to filling the order.
• Customers ordering more than 10 images at a time are eligible for a 50% discount on use fees only.

A.  By any not-for-profit or government agency and by the authors of articles in scholarly journals/magazines/newsletters, teaching tools, videotapes, posters, reports, display, or similar use Describe:___________________________________________________           $10.00    ____  

B.  In a book, e-book, guide, brochure, or similar use  Describe:________________________________

1-5000 copies	$15.00	25,001-30,000 copies	$115.00
5001-10,000 copies	$35.00	30,001-40,000 copies	$135.00
10,001 -15,000 copies	$55.00	40,001-50,000 copies	$155.00
15,001-20,000 copies	$75.00	50,001-60,000 copies	$175.00
20,001-25,000 copies	$95.00	60,001-70,000 copies	$195.00

C.  In a published serial.  Serial title/ date:__________________________________________

1-10,000 copies	$15.00	30,001-40,000 copies	$60.00
10,001-20,000 copies	$30.00	40,001-50,000 copies	$75.00
20,001-30,000	$45.00	50,001-60,000 copies	$90.00

D.  In a DVD, CD, or videotape   Describe:________________________________________

1-1000 copies	$35.00	3001-4000 copies	$90.00
1001-2000 copies	$55.00	4001-5000 copies	$105.00
2001-3000 copies	$75.00	5001-8000 copies	$120.00

E.   Postcards, posters, T-shirts, calendars, mouse pads and/or other non-paper items.   Describe:___________________________________________________________________

F.  On the Web.  Describe:_______________________________________________________
Note:  (1.) The allowable resolution for display is not to exceed 150 DPI or 600 pixels across the long dimension,
whichever is smaller.   (2.) This is an annual agreement, subject to renewal.  (3.) The target website must be in
line with the Center’s goals and mission.  (4.) If the Director of the Center of Southwest Studies is dissatisfied
with the use of the image, the Center will require that the image be pulled from the Web and will refund
(prorated to charge for the period already displayed) the use fees that were paid.
URL of the pages on which the requested image would be displayed: _______________________________
Fee per image, per calendar year of display per web site on which it is displayed.....................     $25.00    ____

G.  Other use.  Describe:_______________________________________________________

Commercial decorative display (offices, stores, restaurants, public areas, events)	$30.00
Book jacket/ magazine cover (1-10,000 copies; ask ahead for prices on larger runs)	$100.00
Commercial motion picture or television broadcast (one-time use only)	$80.00
Non-commercial motion picture or television (e.g., PBS) broadcast	$50.00
Advertising kits and/or press kits	$150.00

3.  HANDLING/ SHIPPING FEES
Handling/mailing fee is $2 per image (minimum $5) in the U.S. and Canada; $3 per image (minimum $8) elsewhere.
(Waived if you pick up the products at the Delaney Library)

REPRODUCTION REQUEST

I request reproduction of the following image(s).  I have noted each item's identifying number and/or brief description.  (Continue on an attached page if necessary.)

All photoprints will have a glossy finish unless a pearl finish is specified.  (Note: glossy is the standard for publications;
              pearl is the most popular finish for display of photos; the third option is satin, which is very flat.)
 

USER'S CONSENT/ HOW THIS IMAGE WILL BE USED
I agree to use the copy image(s) only once and then only for the following stated purpose:
_________________________________________________________________________________________
 
Any special instructions to the photo/digitization lab: _____________________________________________

Purchase of image(s) constitutes agreement to comply with the conditions of use stated on this form.

Please make checks payable to Fort Lewis College.  Or, if you prefer, you may use the Center of Southwest Studies Credit Card Intake Form (on the Web at http://swcenter.fortlewis.edu/Forms/sw-93.htm ) which enables users to make payment to the Center by using a credit card (in person, by letter, by phone, or by fax -- but not by email, due to security considerations).

Signature of User____________________________________________       Date_________________

Form SW-4     Page revised: February 19, 2008

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