Image Request Form – Sligo Library

Local Studies & Archive Image Request Form

Name(Required)

Company - (if applicable)

Email(Required)

Phone(Required)

Address(Required)

Address Address County / State / Region Country

Details of item to be reproduced :(Required)

Publisher, date of publication, intended audience etc

Where will the image be reproduced?(Required)

Book

Journal or newspaper

Exhibition

Other

Other(Required)

Details of the publication, exhibition or other :(Required)

Reproduction of the Image(s)(Required)

I will reproduce the image/s as set out in this document

Use of the Image(Required)

I confirm I will not use the image/s except as set out in this document.

Image credit(Required)

I agree that I will credit the image to Sligo County Library, Local Studies & Archive.

Phone

This field is for validation purposes and should be left unchanged.