A) Copies of items from the manuscript/university archival collection(s) listed below are provided for the research use of with the following understanding:

1. Copies are not to be deposited in any other library or repository.
2. Copies will not be published or used commercially without the written permission of
   a) the owner of the copy/literary rights of the original material and
   b) Georgetown University Library.
3. All responsibility regarding copy/literary rights arising from the use of this material is assumed by the above-named (with signature of agreement below).
4. Access to manuscript and archival material for any purpose involving pending litigation
must be through the office of the University Counsel.
5. The Special Collections Division is not responsible for damage or loss of copies sent by mail.

Your name: Telephone:

Your Mailing Address:

Email address:

Your affiliation:
GU Faculty, staff, or student
Other: (University, business, association, etc.)

Purpose of your request:
General research
Genealogical
GU business
Class assignment
Litigation support
Other :

Intended use of research material:
Commercial/Published media (article, book, exhibition, film/TV)
Non-commercial/personal

Summary of research project/nature of inquiry:

B) Photographic copies are requested for the item(s) listed below:
Please note that some materials cannot be scanned because of their condition.

First item:
Collection name: Box #: Folder#:
Photo size: 4x5 5x7 8x10 11x14 Digital scan, at resolution:
Special instructions:

Second item:
Collection name: Box #: Folder#:
Photo size: 4x5 5x7 8x10 11x14 Digital scan, at resolution:
Special instructions:

Third item:
Collection name: Box #: Folder#:
Photo size: 4x5 5x7 8x10 11x14 Digital scan, at resolution:
Special instructions:

If you are requesting more than three items, please list the rest in the "Additional Information" space provided here.

Additional information to help us process your request (optional):

C) On receipt of payment, this order will be: Mailed Picked up

Your photographic copy order will be completed by David Hagen, Georgetown University Library photographer. If you have questions regarding your order, you may contact him at (202) 687-7530. Billing for photographic copies will be directly from the Photographic Services Department. Payment should be made according to instructions on the invoice.

Please ensure that you have filled out this form completely. Missing information may delay completion of your request.

I have read and agree to abide by the terms and conditions of the Georgetown University Library Special Collections Division Copying Policy.

Checking this box serves as your signature.