Stock Use Evaluation Form − Dipping Into Light

Company/Billing Info
Your Name*
Title
Company Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
*
Phone*
Email*
Job #
Usage Specs
Total # of photos requested
Photo ID #'s
Photo descriptions
Usage type*
End user's name (your client)
End Product*
*
Publication (or presentation) Title*
ISBN #
Main head copy
Publication date*
Date Format: MM slash DD slash YYYY
Press run or Circulation*
Publication size in inches*
Ad size in inches
Image size in inches*
Please note: if size indicated will not match final printed sample, an invoice will be issued for the price difference.
Image size relative to page*
Placement*
*
If more than one publication, please itemize each separately in "other"
Distribution*
Specify Area
Electronic Rights*
- None
- Yes
Duration
Other
Exclusivity*
*
Period of License*
*
Usage period Starts
Date Format: DD slash MM slash YYYY
Usage period Ends
Date Format: DD slash MM slash YYYY
How many times will Ad repeat?
Explain
Usage Rights area*
Languages
Can client provide photo credit?
- Yes
- No
Comments or Questions

Abraham Menashe