LuisenstraÄe Berlin. Spandauer Damm Berlin Robert-Koch-Platz Berlin... Archive Staff Telephone

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1 PHOTOCOPY ORDER FORM Invoice/Receipt No. AR Will be collected Please send I herewith apply for photocopies of the following materials (Collection/System no./title/number of Pages): Date of Production/Invoice: Service Charge % VAT Payable within 30 days Please write on the bank transfer the invoice no. as stated above, together with the word Archive Berliner Bank BLZ: Account no SWIFT Code (BIC): DEUT DE DB110 IBAN: DE The user is responsible for all charges connected with the money transfer. Tax no. 29/033/10720 VAT-Identity-Number: DE Payment Received in Cash Date/Signature of Staff

2 Luisenstraße 60 Chausseestraße 125 APPLICATION FOR PERMISSION TO PUBLISH VISUAL MATERIAL Invoice No. AFP I herewith apply with the Archive of the Akademie der KÖnste for the permission to publish the following images from its collections (collection/system no.): Details of Publication: Independent Publication Essay Radio or TV-Program PhD Exhibition Other* Place of Publication...with... Institution University Company Publishing House Professor... Estimated Dates of Publication or Deadline Edition/no. of Copies I herewith confirm that I am aware of the User Regulations of the Archive of the Akademie der KÖnste and have read the General Terms of Contract concerning the handling of visual material and am committed to obey the rules therein, most particularly concerning the exact mention of the source and the sending of specimen copies. Date and Signature of User. User Fee. + % VAT.. Date and Signature of Staff. Permission for Publication: The Archive of the Akademie der KÖnste accords permission on condition that the User Fee has been paid for the above mentioned materials to be published. This permission does not release the user from the eventual necessity to pay third party rights. Date of Invoice / Signature of Head of Department. Payable within 30 days Please write on the bank transfer the invoice no. as stated above, together with the word Archive Berliner Bank BLZ: Account no SWIFT Code (BIC): DEUT DE DB110 IBAN: DE The user is responsible for all charges connected with the money transfer Tax no. 29/033/10720 VAT-Identity-Number: DE * Please underline appropriate entry

3 PHOTO/SCAN ORDER FORM Invoice / Receipt No. AF x Will be collected x Please send I herewith apply for the production/loan of a reproduction of the following materials (Collection/System no./quantity/ Production Costs Payable within 30 days Please write on the bank transfer the invoice no. as stated above, together with the word Archive Berliner Bank BLZ BLZ: Account no Swift Code (BIC): DEUT DE DB110 IBAN: DE The user is responsible for all charges connected with the money transfer. Tax no. 29/033/10720 VAT-Identity-Number: DE

4 Kárperschaft des áffentlichen Rechts Photo/Scan Order Form Invoice / Receipt No.. User/VAT-Identity-Nr.: - Will be collected - Please send I herewith apply for the production/loan of a reproduction of the following materials (Collection/System no./quantity/ Production Costs Payable within 30 days Please write on the bank transfer the invoice no. as stated above, together with the word Archive Berliner Bank BLZ Account no IBAN DE SWIFT Code (BIC): DEUT DE DB110 The user is responsible for all charges connected with the money transfer. Tax no. 29/033/ VAT-Identity-Number: DE

5 Kárperschaft des áffentlichen Rechts Photo/Scan Order Form Invoice / Receipt No.. User/VAT-Identity-Nr.: Will be collected Please send I herewith apply for the production/loan of a reproduction of the following materials (Collection/System no./quantity/ Production Costs Payable within 30 days Please write on the bank transfer the invoice no. as stated above, together with the word Archive Berliner Bank BLZ Account no IBAN DE SWIFT Code (BIC): DEUT DE DB110 The user is responsible for all charges connected with the money transfer. Tax no. 29/033/ VAT-Identity-Number: DE