Company/Billing InfoYour Name* Title Company Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country* Phone*Email* Job # Usage SpecsTotal # of photos requested Photo ID #'s Photo descriptions Usage type*SelectAdvertisingCorporateEditorialNonprofitEnd user's name (your client) End Product*SelectAnnual ReportBrochureMagazineNewsletterSales AidTextbookBookBillboardPosterPackagingTVOther * Publication (or presentation) Title* ISBN # Main head copy Publication date* 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*Select1/41/23/4Full pageDouble PageVariousVideoPlacement*SelectInsideChapt. OpenerCoverInside CoverBack CoverOtherIf more than one publication, please itemize each separately in "other"* If more than one publication, please itemize each separately in "other"Distribution*SelectNationalRegionalLocalIn-houseOtherSpecify Area Electronic Rights* None Yes Selecttelevisionslide showpowerpointweb 1/4 inside pageweb 1/2 inside pageweb 1/4 front pageweb 1/2 front pageweb, various sizesweb, PDF, 12 monthsweb, PDF, 24 monthsDuration Other Exclusivity*SelectNon-exclusivityExclusivityOther* Period of License*SelectOne-Time3 months6 months12 monthsOther* Usage period Starts DD slash MM slash YYYY Usage period Ends DD slash MM slash YYYY How many times will Ad repeat? ExplainUsage Rights area*SelectNorth American English Language OnlyInternationalOther Languages Can client provide photo credit? Yes No Comments or Questions Δ