Rights and Reproductions Permission Request FormTelephone: (212) 570-3660 /fax: 646-680-7805

e-mail: rights_reproductions@whitney.org

General InformationThank you for your request. Please fill out the information below and either fax or email it to the attention of the Rights and Reproductions Department.TimingPlease allow four weeks for processing requests. A rush fee may be implemented for expedited orders. If new photography is required there will be extra time required to process your request and an additional fee.PaymentPrepayment is required before your order can be shipped; checks, major credit cards, or bank transfers are accepted. You will receive an electronic invoice. Quoted fees expire six months after date of issue.Permission is granted at the sole discretion of the Whitney Museum of American Art.

REQUIRED INFORMATION Date of request:

1. Work(s) requested (list artist, title, date, medium, and accession number for requested works)

2. Information about your publication (title, author, and format [examples: book, web, or magazine])

Title:______________________________________________________________Author/Editor:______________________________________________________

3. Print run and retail price:4. Publication date:5. Publisher’s name and address:

6. Print run and distribution:7. Number of languages:

8. Materials requested (circle one):Transparency/ Black-and-white printDigital (please include estimated reproduction size and desired specs for digital format)

9. Billing information/address:

10. All orders are sent electronically unless shipping is requestedPlease include your account information if you prefer UPS, FedEX, or DHL).

10. Deadline for receiving material: