Application for permission to reproduce British Library images

1. Imaging Services Order number
2. Images Online Invoice number
3. Purchase Order number

1.   Image title / British Library shelfmark /Image ID Size / Cover
2. 1 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+ Do you need the hi-res image(s)? Do you need the hi-res image(s) I already have the hi-res image(s)
3. 2 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
4. 3 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
5. 4 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
6. 5 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
7. 6 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
8. 7 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
9. 8 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
10. 9 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+
11. 10 Please select Up to Full page Front page Back cover Double page spread A5 A4 A3 A2 A1+

1. Media Category How will the image be used? Advertising Editorial Internal Company Use Motion Picture & TV Personal Use Products
2. Media Type Select a specific usage Periodicals Promotional Materials Website Book Display Television Programming Motion Picture Mobile Merchandise Product Packaging
3. Media Detail Select the details of your usage Magazine (Consumer Magazine) Magazine (Trade Magazine) Magazine (Corporate Magazine) Magazine (Education Magazine) Magazine (Consumer Magazine) Magazine (Partworks) Magazine (Custom Published Magazine) Article Corporate Brochure Corporate Calendar Web Page (Content Body) Web Page (Design Element) Training Materials Television Programming Newspaper (Weekly supplement) Newspaper (Tabloid) Newspaper (All Newspaper Types) Retail Book (All Retail Book Types) Textbook (Course Pack) Textbook (All Textbook Types) Reference Book (All Reference Book Types) Trade Book (All Trade Book Types) Wrapper Cover Wrap Gallery Exhibition Museum Display Poster (Educational Poster) Commercial Infomercial Documentary Program Educational Program Entertainment Program News Program Non-Profit Program Prop Set Decor Movie Trailer Documentary Film Web Page (All Web Page Types) All Mobile Types CD ROM Double Postcard DVD Gift Wrap Jigsaw Puzzle Journal Poster (Retail Poster) Retail Calendar (Multi-Page) Retail Postcard Stamp Sticker Packaging For Recordable Media(All Packaging Types) Picture Frame Insert All Product Packaging Types
4. Distribution Format In what format will the image be distributed Print & E-book Electronic Display Printed Recordable Media All Internet Distribution Formats E-Book in Internet Downloadable File E-Book in Internet Website E-Book on Recordable Media Intranet and Extranet Website Projected Display Television Broadcast Mobile Internet Website
5. Title of Production
6. Date of Publication  
7. Print Run Please select One Up to 5 Up to 10 Up to 100 Up to 500 Up to 1,000
8. Duration Please select Up to 6 months Up to 1 year Up to 5 years Up to 10 years Permanent Other (please specify below *)
9. Region -- In what region will the image appear? -- Worldwide Europe Oceania Broad International Region Asia Middle East Northern America Latin America and Caribbean Africa
10. -- Select a specific region -- All Europe All United Kingdom All Eastern Europe Austria Belgium Bulgaria Croatia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Netherlands Norway Poland Portugal Romania Russian Federation San Marino Slovakia Spain Sweden Switzerland Ukraine -- Select a specific region -- All Oceania Australia New Zealand Tahiti -- Select a specific region -- Worldwide Excluding Northern America Worldwide Excluding USA Worldwide Excluding USA and Europe Worldwide Excluding Europe Worldwide Excluding USA and UK All English Speaking Countries All English Speaking Countries Excluding USA Europe, Middle East and Africa USA, Canada and Mexico -- Select a specific region -- All Asia Hong Kong India Japan Kazakhstan North Korea South Korea Kyrgyzstan Malaysia Pakistan Philippines Singapore Uzbekistan -- Select a specific region -- One State Or Province All Middle East Israel Qatar Turkey Yemen -- Select a specific region -- USA and Canada USA Canada -- Select a specific region -- All Latin America and Caribbean All Latin America All Caribbean Brazil Venezuela -- Select a specific region -- All Central Africa All Eastern Africa All Southern Africa Egypt
11. Language -- What languages of text will accompany the image? -- All languages English Finnish French German Greek Hebrew Hindi Hungarian Icelandic Indonesian Irish Gaelic Estonian Dutch Afrikaans Arabic Bosnian Bulgarian Chinese-Cantonese Chinese-Mandarin Chinese-Other Croatian Czech Danish Italian Japanese Slovenian Spanish Swahili Swazi Swedish Tagalog Thai Turkish Ukrainian Yiddish Slovakian Sindhi Korean Latvian Mongolian Norwegian Polish Portuguese Romanian Russian Scottish Gaelic Serbian Other Language
12. Any other relevant information or additional rights

1. Title Mr Mrs Ms Miss Dr Prof Other
2.   If other please specify below
3. Other Title
4. First Name
5. Other Name
6. Last Name
7. Organisation
8. Post / Zip Code
9. Address Line 1
10. Address Line 2
11. Address Line 3
12. Town / City
13. County
14. Country
15. Telephone
16. E-mail
17. VAT Registration number EU Customers only

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