Publication (or presentation) Title
ISBN #
Date
Press Run or Circulation
Publication size in inches
Image Size relative to page
Full page
Double Page
Various
Video
Placement
Chapter Opener
Cover
Inside Cover
Back Cover
Other
Distribution
National
Regional
Local
In-house
Other
Electronic Rights
None
Yes
Exclusivity
Non-exclusivity
Exclusivity
Other
Period of License
3 Months6 Months
12 Months
Other
Usage Period Starts
Usage Period Ends
How many times will Ad repeat?
Explain
Usage Rights Area
North American English Language only
International
Other
Can client provide photo credit?
Yes
No
Comment or Question