JOB DETAILS FORM

First name *

Surname *

Business Name *

Address *

Mobile Number *

Business Number

Email *

Australian Business Number (ABN) *

Method of photo delivery *

Photo (Title, Event, Date and Location of the photo) *

Name the photo that is being requested for licensing

Photo - Description *

Describe the photo that is being requested for licensing

Other photos

List and describe any other required photos here - as requested above

Photo Usage *

Select all that are required

Type of publication/website *

Supply out both if required

Name of publication/website *

Supply both if required

Name of publisher/website author *

Supply both if required

Number of times each photo(s) appear In the publication/website *

Supply both if required

Location of photo(s) within the publication/website *

Supply both if required

Number of print runs of the publication *

Print only

Cost price per print copy: AUD $ *

Print only

Number of copies of the publication in the print run *

Print only

RRP Sale price per copy: AUD $ *

Print only

URL of intended photo(s) location

Web only

Expected income of web use

Web only

Type of license *

(Only non-exclusive is available for the required photo(s)

Duration of license *

PERPETUAL :: Do you want the agreement to automatically renew after the end of the initial term? *

Perpetual option only

PERPETUAL :: If yes - How many years will each renewal period last?

Perpetual option only

LIMITED PERIOD :: Required length of license of the photo(s)?

Limited period option only

Location of use *

SPECIFIC REGIONS :: Specify regions/countries

Specific regions option only

Date *

Client Name *

Client Signature *

The completion of this section confirms that the details supplied on this form are true and correct and also confirms the agreement of the Photo Reproduction Terms and Conditions stated above to go ahead with the creation of a quoted based on the information supplied.