Request for Reproductions

By submitting this form I understand that any reproductions made in response to this request are for my personal research use only, and that these may not be transferred, recopied, broadcast, or published in print or digital form without first obtaining specific permission to do so. I have read and understand these restrictions and those outlined on our Reproductions & Permissions page, and agree to abide by them. I agree to accept financial responsibility for any reproductions made as a result of this order request.

1. Patron Information

Name: Phone:
Address: E-mail:
Date needed:

2. Image Information

Collection # or Call #:
 Collection Name or Item Title:
Box # or Volume #:
 Folder # or Page #:

Descriptive information for item if there are no page numbers:

If you've seen the image online please write the URL here:

If you've seen the image in a Cornell Digital Collection and know the item ID number enter it here:
Include the ID# and description or caption if given.

ID #:
 Image Description:

3. Reproduction Format Requested

Photocopies:
Black and white $.30 per page.
Bound & oversize items $.50 per page.		 Delivery method:

OR

Digital file:

Choose one option below that best suits your needs and the format of the original material.
  Books/bound items:
  Loose/flat items:
  Slides or negatives:
  Pre-existing files:

  Delivery method:
  File will be used for:

4. Special Instructions or Requirements