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 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*

CAPTCHA