Image & Video Requests

Contact Information

First Name*

Last Name*

Company Name

Address

City

State

Zip Code

Country

E-mail Address*

Phone Number*

Date by which you need image or video *

What type of image/video are you requesting from Evident? *

Link to an image/video: *

Image/video Description:*

How will the image/video be used? *

WebPublicationPresentationOther

If other, please explain

Context in which the image(s) will be used *

Will the image(s) be altered or modified in any way (i.e., inclusion of descriptive labels, re-colored, cropped, etc.) *

If yes, how and why

Name of author(s)

Title of publication

Chapter name

Name of publishing company

Address of publishing company

Anticipated publication date

Languages of publication

Format(s) of publication (i.e., print, digital, CD-Rom)

If you already have your personal ID enter it here:

If you already have your personal ID enter it here:

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