Copyright Request Form

Please ensure that you fill in all required fields marked with *

Contact Name: *

Company Name: *

Address: *

Phone: *

Fax: *

Email: *

Details of work by Arthur Boyd that permission is being requested for

Title: *

Medium: *

Do you require an image ?: *

Yes

(Bundanon can provide some images - digital / transparency)

Year:

Extra image 1

Title 1:

Medium:

Year:

Extra image 2

Title:

Medium:

Year:

Extra image 3

Title:

Medium:

Year:

Extra image 4

Title:

Medium:

Year:

Extra image 5

Title:

Medium:

Year:

Details of proposed use of the abovementioned artwork by Arthur Boyd

Publication Type: *

(including electronic publication)

Publication Title: *

Publication Size: *

Image Size in Publication: *

Colour or B&W: *

Colour

Black and White

Print Run: *

Is the Publication for Sale ?: *

Yes

Is the Publication for Educational Purposes ?: *

Yes

If so, please state the recommended retail price:

Further Comments:

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