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 Copies will not be published or used commercially without the written permission of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) Copies are requested for the item(s) listed below:

First item:
Collection name: Box #: Folder#:
Description of item:

Second item:
Collection name: Box #: Folder#:
Description of item:

Third item:
Collection name: Box #: Folder#:
Description of item:

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

Calculating your order total:

Xerox copies cost .25 cents per page for the first 100 pages and .50 cents per page for each page thereafter. Postage and handling costs are $2.00 for orders to be mailed within the US and $5.00 for international requests. (If you do not know how many pages you will need copied, you may leave this blank and we will inform you via email what the page count will be.)

Subtotal:$ . + Postage/handling (if applicable):$ . = TOTAL DUE: $ .

Please mail payment to the following address:

Georgetown University Library
Special Collections Division
Box 571174
ATTN: Copy Order Payment
Washington, DC 20057-1174

Please pay by cash, check or money order made payable to Georgetown University Library. Do not send cash via mail. Copies will be sent on receipt of payment. Thank you.

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 (PDF).

Checking this box serves as your signature.