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DIGITAL SCAN ORDER FORM

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					                            DIGITAL SCAN ORDER FORM
                  UNIVERSITY OF CALIFORNIA, BERKELEY
                 The Earth Sciences and Map Library (510) 643-7041
                      BERKELEY, CALIFORNIA 94720-4767

       Form can be submitted in person or on the phone.
Name: __________________________________________________________________

Address/Department: ______________________________________________________

Email: __________________________________________________________________




Credit Information
The publication must properly credit The Earth Sciences and Map Library.
The preferred credit line is:

Courtesy of the Earth Sciences and Map Library, University of California, Berkeley

Credit for images used in exhibitions must appear within the exhibition area.




Copyright Warning

The granting of permission to use material for publication does not absolve the publisher
from securing permission from the copyright owners and payment of such additional fees
as the copyright owners may require if The Earth Sciences and Map Library does not
own the copyright or if the material is not in the public domain.

The copyright law of the United States (Title 17, U.S. Code) governs the making of
photocopies or other reproductions of copyright material. Under certain conditions
specified in the law, libraries and archives are authorized to furnish a photocopy or
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 scanning order if, in its judgment, fulfillment of the
order would involve violation of the copyright law.




 Job number EART-____________________
                           DIGITAL SCAN ORDER FORM
                  UNIVERSITY OF CALIFORNIA, BERKELEY
                 The Earth Sciences and Map Library (510) 643-7041
                      BERKELEY, CALIFORNIA 94720-4767




Conditions of Use

All digital files remain the property of The Earth Sciences and Map Library.

Statement of responsibility

I certify that the information on this form is correct and I accept the conditions of use.
I am authorized to enter into this agreement on behalf of the above named organization.

Signature ___________________________________________Date:________________


The Earth Sciences and Map Library acknowledges payment in accordance with the
conditions specified herein. Permission is hereby granted to the above for the use
described herein.

Approved ___________________________________________Date:________________




 Job number EART-____________________
                          DIGITAL SCAN ORDER FORM
                   UNIVERSITY OF CALIFORNIA, BERKELEY
                  The Earth Sciences and Map Library (510) 643-7041
                       BERKELEY, CALIFORNIA 94720-4767


Requestor name _________________________________________________________

Requestor email _________________________________________________________


Order Request Information
 Call # / Title                                  Scan Web DVD USB Print                 Total
                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                          0

                                                                            Total

                                                                         Tax (9.75%)

                                                                         Grand Total


FEE SCHEDULE

Scan at 400 DPI                            $25.00 per sheet
                                           (Large maps may be considered as 2 sheets)
Delivered via Web                            Free
Delivered on DVD                           $ 5.00
Delivered on USB Flash Drive               $20.00
Print                                      $20.00


 Job number EART-____________________

				
DOCUMENT INFO