Asset License Request

Questions marked with * are required.

1. Requested AMNH asset (please include specific source information, or link to image location if available): *

2. Usage: *

3. Length of License Agreement Requested (standard license term is 3 years): *

4. Date of license agreement activation: *

5. Will the AMNH asset be used on a cover, or for any marketing, publicity, or promotional uses?: *

Yes

6. Name (of person who will be signing the agreement): *

7. Title (of person who will be signing the agreement): *

8. Organization/Licensee (for the agreement): *

9. Street address: *

10. City: *

11. State: *

12. Zip code: *

13. Telephone: *

14. Email: *

15. Invoice address (if different from agreement address):

16. To whom should the invoice be addressed?:

For PRINT, please provide:

17. Title:

18. Author:

19. Publisher:

20. Pub month/year:

21. Number of pages:

22. Number of total images in the project:

23. Size of print run:

24. Language(s):

25. Region(s):

26. Retail price:

27. Versions (ex. eBook, custom versions, etc.):

28. Additional rights sought (if applicable):

29. Venue:

30. Dates of exhibition:

31. Size of panel/display:

32. Additional rights sought (if applicable):

33. Title:

34. Production company:

35. Air date:

36. Language(s):

37. Distribution channel(s):

38. Additional rights sought (if applicable):

39. Please provide detailed information about how you propose to reuse our content:

40. Miscellaneous notes/comments: