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Image Request Form

Please call 785.864.4710 or email reproductions@ku.edu if you experience any problems with this form.

There are errors in your form! Please review the marked fields below.

Status

Object Information

Artist first name

Artist last name

Title of work

Accession number

What's this?

Date of work

Indicate the number of additional objects requested

Number of additional objects

Object #2

Additional 2 Artist first name

Additional 2 Artist last name

Additional 2 Title of work

Additional 2 Accession number

Additional 2 Date of work

Object #3

Additional 3 Artist first name

Additional 2 Artist last name

Additional 3 Title of work

Additional 3 Accession number

Additional 3 Date of work

Object #4

Additional 4 Artist first name

Additional 4 Artist last name

Additional 4 Title of work

Additional 4 Accession number

Additional 4 Date of work

Object #5

Additional 5 Artist first name

Additional 5 Artist last name

Additional 5 Title of work

Additional 5 Accession number

Additional 5 Date of work

Object #6

Additional 6 Artist first name

Additional 6 Artist last name

Additional 6 Title of work

Additional 6 Accession number

Additional 6 Date of work

Object #7

Additional 7 Artist first name

Additional 7 Artist last name

Additional 7 Title of work

Additional 7 Accession number

Additional 7 Date of work

Object #8

Additional 8 Artist first name

Additional 8 Artist last name

Additional 8 Title of work

Additional 8 Accession number

Additional 8 Date of work

Object #9

Additional 9 Artist first name

Additional 9 Artist last name

Additional 9 Title of work

Additional 9 Accession number

Additional 9 Date of work

Object #10

Additional 10 Artist first name

Additional 10 Artist last name

Additional 10 Title of work

Additional 10 Accession number

Additional 10 Date of work

Accession number(s)

Reproduction Information

Format

Intended use

Additional information

Publication Information

Title of publication

Author first name

Author last name

Edition

Expected publication date

Publisher city

Publisher country

Press run

Language

English

German

Chinese

French

Spanish

Italian

World Rights (all languages)

Japanese

Other

Other language

Reproduction size

¼ Page

½ Page

Full Page

Cover

Contact Information

First name

Last name

Address line 1

Address line 2

City

State/Province/Region

Zip/Postal code

Country

Primary phone

Email