IMAGE REQUEST FORM

Thank you for your interest in an image from the Saint Louis Art Museum's collection.
Please fill out the following information in as much detail as possible. You can also download the form by clicking here, and return it by email (as an attachment), fax, or mail.

Email: Fax: Mail:	Image.Request@slam.org 314.721.6172 Saint Louis Art Museum Attn: Photography & Image Rights Manager One Fine Arts Drive, Forest Park St. Louis, Missouri 63110
CONTACT INFORMATION
Name:
Email:
Organization:
Mailing Address:
Phone:		Fax:
IMAGE(S) REQUESTED
1. Artist
Title:		Object #
2. Artist
Title:		Object #
3. Artist
Title:		Object #
4. Artist
Title:		Object #
Please add any additional images to the end.
DESCRIPTION OF USE
Check all applicable:
Printed Publication		Study or Personal use
Type:		Online Publication
Scholarly or General Book		Film/Video
Textbook		Press and Publicitiy for Exhibitions
Children's Book		Merchandise
Exhibition Catalogue		Lecture/Education Presentation
Article for Scholarly Journal		Other
Article for Magazine		Describe:
Other, describe:
PROJECT/PUBLICATION INFORMATION
Enter where applicable:
Project Title
Author/Director
Publisher/Producer
Website URL
Projected Publication Date / Production Date
Print Run / Copies Distributed
Distribution	North America Worldwide		Other
Language:	Single Language	Multilanguage
Retail Price
Will the images appear as:		Cover	Interior
At the size:	Full page ½ Page ¼ Page Less than ¼ Page A4
In:	Color	Black and White
Do you already have an image?		No	Yes
If yes, images source
What size and resolution do you need?
Do you plan to publish a detail?		No	Yes
If yes, describe:
Is this a first edition, second edition, or subsequent edition?
Are you working with a deadline?
Please list any additional information, details or additional image request information
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