Kindly fill the following form to get an image quotation based on your usage requirements.

You may use as well this form to send us ad-hoc requests for specific pictures or for simple feedback by using the "Special request" box below.

Yourself

Name
E-mail
Company
Phone
Fax

Wich picture?

Reference	Such as uw001_01, as displayed under each picture in the galleries. For multiple pictures, please separate the references by a comma.
Title/Subject

Wich usage?

Exclusive rights ?

Yes No

Publication type	Magazine Advertising Brochure Postcards Coffe table book Internet/Web Personal Others
	If others, please specify

Regional scope	Worldwide Continent Country
	If continent or country, please specify

Print-run	Number of copies to be printed
Duration	How long do you need the rights on the picture ?
Your budget	in $US

Image format

Image media

Transparency Print Scan

Image size

pixels cm inches Please specify for scans or prints

Scan type

RGB CMYK

Scan format	TIFF JPEG Others
	If others, please specify

Scan resolution

DPI Please specify for scans

Scan media

CD ROM E-mail FTP

Special requests

Feel free to post here your specific requirements, your comments, your questions...

Please type the above cyptogram :