Image License Form

Business Name

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Country

(###)

###

####

ABN or VAT Number

Photography Location

Photography Date

YYYY

Line

Photography License

E.g. Campaign Name

License Type

Please Select

Filenames

Usage

Print Volume

Website

Social Media

License Start Date

YYYY

License End Date

Leave Blank If Unlimited

YYYY

Territory

Single or Batch Image License

Single

Batch

Line

Briefing Received?

Number of Images Delivered?

Photographs to be delivered by

YYYY

Creative Fee inc GST

Deposit Paid

Yes

Deposit Date

YYYY

Thank you for filling out the Image License.

Next, you will be taken to a Digital Docusign to verify the agreement.

Please stand by and follow the on-screen prompts.

You will be returned to the home page on completion.