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company/billing information
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1
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Your name
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2
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Title
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3
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Company Name
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4
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Street
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5
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City
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State Zip Code
Country USA Other
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6
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Day Phone
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7
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Fax |
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8
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Email
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9
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•
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usage specs
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12
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Total # of
photos requested
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13
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Photo ID numbers
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14
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Photo descriptions
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15
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Usage type
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Advertising Corporate Editorial Nonprofit |
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16
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End user's name
(your client)
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17
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End Product
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Annual Report Brochure Magazine Newsletter Sales Aid
Textbook Book Billboard Poster Packaging TV
Other
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18
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Publication (or
presentation) title
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ISBN #
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19
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Main head copy
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20
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Publication date
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21
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Press run
or circulation
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if more than one publication, please itemize each separately
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22
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Publication size
in Inches
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if not applicable, write "0"
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23
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Ad size in inches
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24
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Image Size
in Inches
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please provide accurate image dimensions / if slide/video, enter "video"
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25
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Image size
relative to page
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1/4 1/2 3/4 full page Double Page Various Video
please note: if size indicated will not match your finished printed
sample, an invoice will be issued for the price difference. |
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26
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Placement
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Inside Chapt. Opener Cover Inside Cover Back Cover
Other
If more than one publication, please itemize each separately in "other" |
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27
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Distribution
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National Regional Local In-house
Specify Area |
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28
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Electronic Rights |
None
Yes:
Duration
Other |
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29
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Exclusivity
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Non-exclusive Exclusive Other
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30
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Period of License
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One-Time 3 months 6 months 12 months
Other
Usage period begins (d/m/y) Ends (d/m/y)
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31
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How many times
will the Ad repeat?
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Explain
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32
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Usage rights area
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North American English Language Only International
Other
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33
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Languages |
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34
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Can client provide
photo credit?
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Yes No |
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comments, questions, or other information
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35
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