Image Order Form

Name:
Address:
City:	State:   Zip:
Phone:
Email:

Order Information:

Date of Request:  
Date Needed By:   

WSHS Member Yes
No

Non-Profit Organization Yes
No

Use of images, media content - Other - please describe (please refer to list on Photo and Image Duplication Services and Prices page):

Order Delivery Mail
Pick Up

Description of Image request [Image Accession number(s) / Image quantity / Image type (digital file/print/transparency)/ Image size (8X10 or other) or Digital file resolution (300 dpi/600 dpi) / Photograph paper (glossy or matte)]:

Please refer to our Image Use and Policy Page for terms and conditions which apply to this order. Once you have selected the submit order button below, you will be contacted by a WSHS staff member to complete a licensing agreement and payment processing for completion of the order.