Reproduction and Permission to Publish Form
Name:
Phone:
Organization or Agency (if applicable):
Address:
Email Address:
Ex.
Identifier (e.g., Collection number, Photo number, Key number,
Box and Folder number) and Description
MSS 0019-813 Alfred C. Finn Collection—first filling station
Digital, Print,
or Reuse
Digital
Resolution
or Print Size
300 dpi
Qty.
Price
1
12.50
1.
2.
3.
4.
5.*
Total
*For more than five items, fill out the Additional Reproduction Requests form.
Payment must be made at time of order. This form acts as an invoice. Proceeds from reproduction sales go toward the costs of
preservation of photographs and archival materials. Orders take approximately 10 business days from the date of payment.
NOTICE
WARNING CONCERNING COPYRIGHT RESTRICTIONS
The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted
material.
Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these
specified conditions is that the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship, or research.” If
a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of “fair use,” that user may be liable for copyright
infringement.
This institution reserves the right to refuse to accept a copying order, if, in its judgment, fulfillment of the order would involve violation of
copyright law.
HMRC Staff Use Only
Order Taken by: ___________________
Delivery Method (circle one):
Date and Time: ____________________
In person pick-up
Mail
Electronic Delivery
Method of Payment: ___________________
Intended Use
Complete as applicable. If unknown, please write NEED TO UPDATE so this form can be completed at a later date.
Title or Description of Use:
Author / Producer:
Format (check all that apply):
Publisher:
Book ___ Dissertation ___ Film/Video Program ___ Periodical ___
Presentation ___ School Project/Paper ___ Social Media ___ Web Content ___
Other (please specify):
Conditions of Use
All requests to reproduce the Houston Metropolitan Research Center’s (HMRC) holdings, which may include photographs,
architectural drawings, maps, and other documents, must be submitted on this form.
1.
Permission for reproduction is limited to the applicant and is non-transferrable and may not be reused on another project,
assigned, or sold without the permission of HMRC. Permission for reproduction is granted only for the express purpose
described in this form. HMRC reserves the right to reproduce the image or document and to allow others permission to reproduce
the image or document.
2. Reproductions supplied by the repository may not be copied, scanned, exhibited, resold, or used for any other purpose than that
specified in this application. Audio-visual material may not be reproduced for any reason except that of supplying additional
copies for production requirements. Copies shall not be deposited in another library, archive, or repository.
3. Any subsequent use or any change in use from that stated on this form (e.g. subsequent edition) constitutes reuse and must be
applied for in writing to HMRC.
4. HMRC reserves the right to refuse reproduction of its holdings if it feels fulfillment of that request would violate copyright or
other laws or if the materials are deemed unsuitable for reproduction on account of condition, sensitivity, or privacy concerns.
HMRC reserves the right to require a release from individuals whose privacy may be violated by the reproduction of an image.
5. It is the responsibility of the applicant to obtain permission to publish from the owner of the copyright (for HMRC, the creator of
the record, the author or his/her transferees or heirs).
6. HMRC assumes no responsibility for any royalties or fees claimed by the material’s creator, artist, or photographer, or on their
behalf.
7. In all instances, the applicant agrees to hold the repository and its agents harmless against any and all claims arising or resulting
from the use of the material and shall indemnify the repository and its agents for any and all costs and damages arising or
resulting from any such unauthorized use.
8. Unless approved in advance by HMRC, the integrity of the image must be maintained.
9. Files of scanned images delivered electronically must be destroyed once the final product has been produced.
10. The applicant covenants, represents, and warrants that the product will not contain any feature that would permit users to distort
or mutilate the image, nor will the product be intentionally designed or prepared so as to be compatible with any computer
program which is designed to manipulate images.
11. The applicant agrees to send HMRC one copy, free of charge, of the work containing the reproduction(s) for inclusion into the
HMRC collection at the discretion of HMRC. All expenses for shipping and handling are to be borne by the applicant.
12. All reproductions must include, in a caption, end note, or credit, the name of the repository and the identifier of the item. For
example: MSS 1248-3714, Houston Public Library, HMRC. Credits should appear in close proximity to the image or in a
special section devoted to credits in clearly visible and legible type.
Endorsements
By signing this form, I accept personally and on behalf of any organization I represent, the conditions set forth within:
Signed
Date
When signed by an authorized agent of HMRC, this form/invoice constitutes permission for reproduction as outlined herein.
Signed
Date
Additional Reproduction Requests Form
Name:
Ex.
Date:
Identifier (e.g., Collection number, Photo number, Key number,
Box and Folder number) and Description
MSS 0019-813 Alfred C. Finn Collection—first filling station
Digital, Print,
or Reuse
Digital
Resolution
or Print Size
300 dpi
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Total
Qty.
Price
1
12.50