P R A G U E
C I T Y
A R C H I V E S
REGISTRATION No. OF THE RESEARCHER:
XEROX / DIGITAL COPY ORDER FORM
Ordering institution /person Name Address (Registered office) Street Municipality Country List of selected archival materials Collection name Details (call numbers, inventory numbers, pages etc.) Part of the municipality E-mail House No Postal Code
/
NAD No
Total number of copies Please make 1) Xerox copies Xerox copies A4 format One-sided copies 2) Digital copies Options Output on Payment options JPG, 300 DPI CD/DVD Cash TIFF, 600 DPI PRINT Bank transfer Digital copies A3 format Two-sided copies
I hereby confirm with my signature that: 1) 2) I have read the Price List of the copy services provided by the public archives (which forms an Appendix No 4 to the Decree No 645/2004 Coll.), namely its Part 4 (Reprographic services using digital technologies ); the Price List is available in the Reading Room. In case of digital copies, I am liable to conclude an agreement with the Prague City Archives on the permission to copy the document and on the provision of a oneoff reproduction right (including in case of copies made for personal use); I am also liable to pay any relevant statutory fees according to the purpose for which the copies are made. I hereby acknowledge that if the copies of archival materials are used and published without the consent of the Prague City Archives, or for any other purpose than agreed herein, the Prague City Archives shall claim from me (the photographer) a subsequent payment for its consent to the reproduction, increased by a sanction charge amounting to 100%.
3)
Date
Signature