Image License Request & Grant Form

Creating Lasting Memories Through Beautiful Photography.

Requested image identifiers, usage description, media, territory, duration, exclusivity, fee, and countersigned grant of license.

BTL-PBL-18.020

Form

Vol 18 — Commercial & Brand Photography Division

Header

Client / Project *

Date *

Prepared by *

Purpose *

Line 1

Line 2

Line 3

Line 4

Line 5

Additional notes

Prepared by *

Signature *

Date *

Prepared by

Name · Title · Date

Reviewed by

Name · Title · Date

Approved by

Owner · Katheryn L. Wilkins · Date

Controlled document — BTL-PBL-18.020. Complete all required fields (marked *). Retain per Volume 15 retention schedule.