Cline Library
Special Collections and Archives
P.O. Box 6022
Flagstaff, AZ 86011-6022
(928) 523-5551 Fax: (928) 523-3770

REPRODUCTION ORDER FORM

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Request copies of archival images, sound files, and films. If you plan to use the copies for purposes of publication, reproduction, exhibit, or public display, completion of the permission to publish form is required. Commercial use fees are based on the type of intended use. Non-profit users are not subject to commercial fees, but are required to provide their Non-Profit 501(c)(3) I.D. Number. Please fill in all fields that are denoted with an asterisk (*).

*Patron name:
Institution/Dept./Business:
*Mailing Address:
*City:
*State or Province:
*Postal Code:
Country:
*E-mail address:
*Daytime Phone Number:
Fax Number:
Intended Use:

Please provide details of your intended non-profit or commercial use:

All non-profit and commercial users must also print and submit by fax or mail a permission to publish form

Local call number	Quantity	Processing services	Cost	Type of use	Fees







		Subtotal		Use Fees
		Rush Fee (100% of Total)
				FedEX #
		Total

Special Instructions: