PMM Permission Request Form

This form is for permission requests only. Images must be ordered separately.

Because I intend to use images belonging to the Penobscot Marine Museum for other than personal use, I therefore understand and agree that:

1. The materials and/or copies are furnished without representation or warranty as to any rights therein and the use thereof shall be entirely at my own risk.

2. I hereby agree to defend and indemnify and save and hold you, the Penobscot Marine Museum, its officers, and/or its employees or designates harmless from and against any and all liability, including costs and expenses based on the violation of rights of ownership, infringement of copyright, or invasion of the rights of privacy, or laws of libel resulting from my use of such materials or copies furnished pursuant hereto.

3. I will not use or authorize others to use the material or copies furnished me for any purpose whatsoever, including all forms of publication or exhibit, except as specifically provided in this agreement, without first obtaining the written consent of the Penobscot Marine Museum.

4. I agree to use any image provided without significantly altering it through conventional or electronic means. Altering the image beyond standard cropping and resizing requires further discussion with the museum’s staff. A cropped image must specify that it is a detail of the full image.

5. I will supply the following credit line when reproducing materials: Courtesy Penobscot Marine Museum. All reproductions must be captioned with appropriate image ID numbers (i.e. “PMM Image ID __”).

6. I agree to pay in advance the assessed permission/use charges for my use of any images provided.

7. I am authorized to enter into this agreement on behalf of the organization named below and enter into the agreement on behalf of that organization and of myself.

Your Name (required)

Title

Address

City

State

Zip

County

Your Email (required)

Phone

Fax

Project Information:

Please list the ID number and brief description of the images you wish to use in your project.

Image 1

Image 2

Image 3

Image 4

Image 5

Name/title of project

Author, Editor, Director

Estimated date of publication (month/day/year)

Format (please check all that apply to your project):

Format if Other

Publisher/Production Company Information

Company

Address

City

State

Zip

Country

Company Email

Phone

Fax

Distribution Information (please check all that apply to your project):
 Print: Cover Print: Reprint/reuse TV: Local Markets, one-time use TV: Local Market with Repeats TV: Network/syndicate/cable, one-time TV: Network/syndicate/cable w/Repeats