Scanning Request Form

$8.00/scan     x         ______ = $________

$4.00/Jewel Case  x   _____ = $________

$1.00/Sheet of Paper x ____ = $________

Total                                          $________

Note: Please consult fee schedule for prices, terms, and conditions.

                                                                                   

Name: __________________________________________

Address: ________________________________________

City/State/Zip: ___________________________________

E-Mail: _________________________________________

Phone: __________________________________________

 

Please Select:  JPEG   TIFF   Format:  Print     CD 

Resolution:   300 dpi   600 dpi   Other   Please Specify ________ Image Size:  4 x 6   5 x 7   8 x 10   Custom

 

 

Collection Title

Box/Binder #

Album #

Folder/Squadron #

Type of Original

Description of Image

1

 

 

 

 

Print         Negative          Slide

 

2

 

 

 

 

Print         Negative          Slide

 

3

 

 

 

 

Print         Negative          Slide

 

4

 

 

 

 

Print         Negative          Slide

 

5

 

 

 

 

Print         Negative          Slide

 

6

 

 

 

 

Print         Negative          Slide

 

7

 

 

 

 

Print         Negative          Slide

 

8

 

 

 

 

Print         Negative          Slide

 

 

Notice:  Warning Concerning Copyright Restrictions

The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material.

 

Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction.  One of the specified conditions is that the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship, or research.”  If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of “fair use,” that user may be liable for copyright infringement.

 

The institution reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law.

By signing this form I agree to assume all responsibility for compliance with the copyright laws and to hold harmless The University of Texas at Dallas, its agents, and employees from any legal action which may arise as a result of this transaction.

 

Name:________________________________________________________________________   Date:____________________