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Digital Image Request Form


* Asterisk denotes required field

Contact Information

Shipping Address

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Billing Address

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Item Description

Item #1

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Image Use Description

If you plan on using digital images in any type of publication, please allow two weeks for the Purdue Research Foundation to generate the necessary contract.

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If these items will be used in publications, media productions, or exhibits then complete the next 3 questions.






 

External or Internal Request

Please choose one image request type, External or Internal:

External requests: Image requests for the public

Choose one external request option:

  • Company billing option

    Enter your company name in the Organization field above in order to have billing sent to and filed under the company name.

  • Individual billing option

    If billing is to an individual instead of a company please enter the last 4 digits of you Social Security number and your middle name.Purdue University requries this information for identification purposes.




Internal requests: Image requests from Purdue University departments

NOTE: You must have a Purdue University department invoice number to be considered an Internal request.

Choose one internal request option:



  • Please enter your Purdue Department invoice number.






Service Priority

Priority Service: If your desired delivery date is 2 working days from today there is an additional 50% charge of the total cost.

Rush Service: If your desired delivery date is one day from today then there is an additional 100% charge of the total cost.