_______________________________________________ _____________________________

 Customer Name

 Date

 

CUSTOMER COPYRIGHT DECLARATION FORM

I understand that making copies of photographs must be authorized by the photographer, or fall within certain limited exceptions. I make the following statements concerning my request for copies of the accompanying film, print, slide, movie, artwork, CD ROM, disk or other material (all referred to in this document as the "photos"):

___________________________________________________________________________

(Describe the content of the photos)

 1.

I AM THE PHOTOGRAPHER, OR HAVE RECEIVED SUCH AUTHORIZATION.
  [Does not apply where the photo is marked as a professional photo, or altered.]

 2

THE COPY REQUEST IS FOR PERSONAL USE AND HAS SPECIAL CIRCUMSTANCES:
   _________________________________________________________________
 
  Described above the special circumstances which indicate the photographer is unlikely to object to the copying.
  _____Insert the approximate age of the photo.
  _____The original print is damaged and I want the print restored.
  _____The photographer is unknown or cannot be located.
  _____All reasonable efforts have been made to contact the photographer to obtain permission.
 
  Describe the effort made to contact the photographer.
  _____Asked for name of City where photo was taken
  _____Checked telephone book.
  _____Called PPA Locator service (700-786-6277).
  _____Other: Describe
   

 3.

THE COPY REQUEST IS FOR A "FAIR USE":
  There is no automatic "fair use." This request must be evaluated after considering all of the circumstances. Describe all the circumstances. Among those to consider are:
  a. Use for criticism, comment, news reporting, teaching, scholarship or research. (Circle all that apply.)
  b. Whether the use is for commercial or non-commercial purposes.
  c. The amount or portion of the photo being copied.
  d. The number of copies requested.
  e. The impact of the copies on the photographer's potential resale market.
  f. Whether the copy serves the same function as the original.
  Specify the facts to support the claim and describe the intended use:
   

Customer agrees to pay the charges for processing and/or printing the photos, and to indemnify and hold harmless ______________________ (Your company name) and its agents for all liability, damages and expenses (including reasonable actual attorney fees) it may incur as a result of its processing and/or printing the photos, including any claims brought by an other person claiming an interest in the photos or in their subject matter.

__________________________________________________________________________________

Customer

Address:___________________________________________________________________________

Telephone Number:Accepted By:________________________________________________________

Dealer/Lab _________________________________________________________________________

LAB IS TO KEEP THIS FORM AFTER PROCESSING