Local History Purchase Order
Image
*
Please list the ID #, required format (print or scan) and required scan resolution for all image orders. Scans will be saved as 300 dpi jpeg unless otherwise specified. Upon receiving a completed purchase order you will be invoiced for the amount owing.
ID #
Print
Scan
Resolution (scans only)
Intended Use
*
Check all that apply
Personal use
Magazine
Newspaper
Website
Resale
Public display
Book / eBook
Research / Study
Other
Other Intended Use
Project Description
*
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Email
*
Phone
*
Consent
*
I, the undersigned, confrm that the information I have provided is correct and I accept the conditions of use as stated on this form
*
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