graphica tm

Permission Request Form

Please provide the following information. It will be sent to the image copyright holders of Graphica 1 and Graphica2.

Today's date: 19 June 2018

1. Name
2. Organization
3. Email address
4. Phone number


5. Which images would you like to use?
(Please either (1) give the URL where they appear, (2) give their name, e.g.: "Bakshee3", or (3) describe them.)


6. How many images would you like to use?


7. In what file format?


8. I would like to include image(s) on a printed document.

    8.a. What is the purpose of the document?
    8.b. Do you plan to sell it? Yes No
    8.c. How many copies do you plan to print?
    8.d. Will you use image(s) on subsequent editions or versions? Yes No


9. I would like to include image(s) on a website.

    9.a. What is its URL?
    9.b. What is the purpose of the website?
    9.c. Do you plan to sell products on (or access to) the website? Yes No
    9.d. How many visitors per month to your website do you anticipate?


10. Date of publication


11. Where in the document/site would the images be used--e.g., cover, home page? And at what size?


12. Other comments/questions:


13. Just to prove you're human, please answer this: 14+3 =