COMMERCIAL PERMISSION REQUEST AND AGREEMENT FORM
Permissions Office • Peabody Museum of Natural History • Yale University
170 Whitney Avenue • P.O. Box 208118 • New Haven, CT 06520-8118 USA
(203) 432-3786 • FAX (203) 432-5872
http://www.peabody.yale.edu • peabody.permissions@yale.edu
1. Contact Information
Please print clearly. Fax or mail your completed and signed form to the Permissions Office.
Requestor:
Licensee (if different from Requestor):
Name ______________________________________________________
Name ______________________________________________________
Company __________________________________________________
Company __________________________________________________
Address ___________________________________________________
Address ___________________________________________________
____________________________________________________________
____________________________________________________________
City _______________________________________________________
City _______________________________________________________
State ________________________ Zip code ____________________
State ________________________ Zip code ____________________
Country ____________________________________________________
Country ____________________________________________________
Telephone _________________________________________________
Telephone _________________________________________________
Fax ________________________________________________________
Fax ________________________________________________________
E-mail _____________________________________________________
E-mail _____________________________________________________
2. Materials Requested
Date Needed:
_____________________________________________
□ Image(s):
Image Nos. ___________________________________ YPM Catalog Nos. _______________________________________
________________________________
_______________________________________
Description: ____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
□ Data
□ Text (attach separate sheet with exact text and bibliographic source information)
EXPRESS DELIVERY REQUESTED
□ Yes, bill account below
Courier ________________________________
3. Usage Rights
□ Yes, bill me directly
□ No
Custormer Account No. ______________________________________________________
Respond to all questions appropriate for your project. Please print clearly.
Category of Use
Rights Requested
□ PRINT: □ Textbook
□ Tradebook
□ Magazine
□ North American/English
□ Catalog
□ Exhibition
❑ Journal
□ Worldwide/all languages □ One country/one language
□ Corporate
□ Ad
□ Other __________
□ One time use
Publisher/Agency ___________________________________________
Author/Client _______________________________________________
□ FILM, VIDEO, DVD & TELEVISION:
Producer(s) Names(s) _______________________________________
Channel/Networks __________________________________________
Scheduled airing date(s)& time(s) ____________________________
□ Worldwide/one language
□ Re-use
□ Multiple use/License
Title (book/product/program/exhibition)
____________________________________________________________
Distribution
Publication/Distribution Date ________________________________
Print run/No. of Units _____________ List price ________________
Frequency/Circulation ____________ Time Period______________
Length of program __________________________________________
Amount of time YPM material will appear _____________________
□ ELECTRONIC:
□ CD-ROM
A. □ Full Color □ B&W
B. □ Halftone
❑ Line Art
Reproduction Size
□ Other __________________________________
□ Website (provide URL): __________________________________
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Image Type
□ Cover
□ Spread
□ Full Page
□ Other __________
□ 1/2 Page □ 1/3 Page □ 1/4 Page or Spot
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4. Terms and Conditions
1. PERMISSION
This document identifies the following:
(A) the intellectual property — images,
data or text — (“Property”) in the possession of the Peabody Museum of
Natural History (“YPM”); (B) the requestor (“Licensee”) who seeks to use
the Property; and (C) the Licensee’s intended use of such Property. When
signed by YPM, YPM grant to the Licensee the right to reproduce the Property, subject to the following conditions:
(a) the right is nonexclusive and nontransferable; (b) the right is subject to
the terms and conditions and representations set forth in this entire document;
and (c) the right is subject to any fee
schedules or other attachments that
shall be deemed an integral part of this
agreement.
2. WARRANTY AND ACCEPTANCE
Licensee hereby warrants the accuracy
of the representations made in this
agreement. Licensee agrees to publish
the Property only in accordance with
the terms of this agreement and to
comply with all its terms. Licensee
agrees that each permission is for onetime use, and any further or subsequent
use of the Property is subject to the execution of an additional permission
agreement. Licensee further agrees that
it shall not alter the Property without
the express written permission of YPM.
3. DELIVERY
YPM will endeavor to deliver the requested Property within four (4) weeks
of the acceptance of Licensee’s request. The Property will be sent First
Class postage, unless Licensee specifies and agrees to pay for express delivery. On completion of the permitted
reproduction, Licensee shall return any
media, if applicable, to YPM in New
Haven, Connecticut, in the same condition as delivered to Licensee. Purchased physical media of the Property
need not be returned, unless specifically requested; in any case the Property may not be reproduced again without an additional permission
agreement. Licensee agrees to pay all
additional fees for late return, damage
to, or loss of the media identified on the
fee schedule.
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4. RIGHTS AND COPYRIGHT
YPM shall at all times retain all rights to
the Property, including copyright where
applicable, and Licensee agrees to exercise due care in the protection of such
rights. Licensee agrees that no part of
the Property may be reproduced in any
form without YPM’s express written
consent, and that any reproduction of
the Property must include the credit line
indicated in this agreement. Licensee
agrees to undertake other such measures as may be reasonably requested
by YPM to assist in the tracing of any
unauthorized copies. If YPM does not
hold the copyright to the Property, Licensee agrees to obtain the permission
of the copyright holder prior to publication, to pay any necessary fees in connection with such permission, and to
hold YPM harmless in the event that
such permission is not obtained.
5. TERMINATION
In the event the Licensee shall fail to
keep, perform, or observe the terms
and conditions of this agreement, including prompt payment of royalties,
YPM shall have the right to terminate
the permission agreement on fourteen
(14) days’ written notice by Certified
Mail, Return Receipt Requested, to Licensee. During these fourteen (14)
days, Licensee shall have the right to
remedy such failure(s). When YPM receives evidence of such remedy, the
termination notice shall have no further
force or effect.
6. USE OF NAMES
Except for publication in recognized research journals or otherwise in connection with other academic or scholarly
purposes, including the references required under section 6 of this permission agreement, Licensee shall not employ or use the names Yale, Yale
University, Yale Peabody Museum, or
Peabody Museum of Natural History in
any publications, promotional materials,
or advertising without YPM’s prior express written consent.
CLUDING WITHOUT LIMITATION, IMPLIED WARRANTIES OF MERCHANTABILITY, OF FITNESS OF THE
IMAGES FOR A PARTICULAR PURPOSE, OR AGAINST INFRINGEMENT
OF THE RIGHTS OF THIRD PARTIES,
OR WITH RESPECT TO COPYRIGHT
IN ANY IMAGE.
8. ASSIGNMENT
The Licensee shall not assign this permission to any third party without the
prior express written consent of the
YPM, and any purported assignment
without such consent shall be void.
9. TAXES
Licensee shall be entirely responsible
for and shall pay any and all duties,
taxes, including but not limited to Value
Added Tax, assessments and fines
levied by U.S. or Canadian federal,
state, provincial, or local authority in
connection with the activities contemplated by this permission.
10. RELATIONSHIP OF THE PARTIES
Licensee is an independent contractor
and nothing contained in this permission shall be deemed or interpreted to
constitute Licensee to be the agent or
legal representative of YPM for any purpose whatsoever. Licensee is not
granted any right or authority to assume or create any obligation or responsibility, expressed or implied, on
behalf or in the name of YPM, or to
bind YPM in any manner or fashion
whatsoever.
11. ENTIRE AGREEMENT AND
AMENDMENTS
This permission agreement contains the
entire agreement between the parties.
No amendments or modifications to
this permission agreement shall be effective unless made in writing and
signed by an authorized representative
of both parties.
12. LAW AND FORUM
This permission agreement shall be
construed in accordance with and governed by the laws of the State of Connecticut. Licensee hereby consents to
7. WARRANTIES
the jurisdiction of the courts of the
YPM MAKES NO WARRANTIES OR
REPRESENTATIONS EITHER EXPRESS State of Connecticut.
OR IMPLIED, AS TO ANY MATTER, IN-
5. Payment Information
Page 3 of 3
Bill to:
Ship to (if different from billing address):
Name ______________________________________________________
Name ______________________________________________________
Company __________________________________________________
Company __________________________________________________
Address ___________________________________________________
Address ___________________________________________________
____________________________________________________________
____________________________________________________________
City _______________________________________________________
City _______________________________________________________
State ________________________ Zip code ____________________
State ________________________ Zip code ____________________
Country ____________________________________________________
Country ____________________________________________________
Telephone _________________________________________________
Telephone _________________________________________________
Fax ________________________________________________________
Fax ________________________________________________________
E-mail _____________________________________________________
E-mail _____________________________________________________
Licensee agrees to pay to YPM all photographic charges and postage and handling fees in accordance with YPM’s posted fee
schedule. Licensee agrees to send to YPM one copy of the finished work.
Licensee shall pay to YPM, in immediately available U.S. dollar funds drawn on a U.S. bank, the full amount of all fees, due on
receipt of YPM’s invoice and in advance of receipt of the Property, prior to publication. Payment by credit card is preferred and
provides the fastest service. Make checks payable to Yale University, include reference to the YPM invoice number, and deliver to:
Permissions Office
Peabody Museum of Natural History, Yale University
170 Whitney Avenue, P.O. Box 208118
New Haven, CT 06520-8118 USA
CHARGE MY CREDIT CARD:
Card no.
□ VISA
□ MasterCard
________________________________________________________________ Expiration __________________________________
Name on card ____________________________________________________________ Security code _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature ______________________________________________________________________________________________________________
6. Permission
The Peabody Museum of Natural History, Yale University, grants the one-time, nonexclusive right to the undersigned Licensee to reproduce the materials indicated in this agreement for the usage indicated herein. The granting of rights for YPM materials is contingent on the payment of all fees. Payment in advance of publication or production of product is required. By signing this form, the Licensee confirms the accuracy of the above representations and agrees to comply with the terms of this document, and any additional
terms attached to this form by YPM. If the request is approved, a fully executed copy of this agreement will be returned with an invoice and the materials for which the permission has been granted.
□ If this box is checked, the Licensee must submit final copy for review. YPM reserves the right to: (A) review the final context or product
prior to publication or reproduction in which YPM image(s) appear, and (B) to approve or reject the proposed use of image(s).
All reproductions must show the following credit line (to be completed by YPM):
□ Copyright © _________ Peabody Museum of Natural History, Yale University, New Haven, Connecticut, USA.
YPM catalog no. _____________________________ Photography by _______________________________________________________.
□ Courtesy of the Peabody Museum of Natural History, Yale University, New Haven, Connecticut, USA.
□ The Age of Reptiles, a mural by Rudolph F. Zallinger. Copyright © 1966, 1975, 1985, 1989, Peabody Museum of Natural History,
Yale University, New Haven, Connecticut, USA.
□ The Age of Mammals, a mural by Rudolph F. Zallinger. Copyright © 1966, 1975, 1989, 1991, 2000 Peabody Museum of Natural
History, Yale University, New Haven, Connecticut, USA.
I have read and understood this agreement
and accept its terms and conditions.
For the Peabody Museum of Natural History,
Yale University:
Licensee (please print) ______________________________________
YPM Agent (print) ___________________________________________
Signature __________________________________________________
Signature___________________________________________________
Title________________________________________________________
Title _______________________________________________________
Date _______________________________________________________
Date _______________________________________________________
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