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| ORGANIZATION SUBMITTING REQUEST |
| *Business Name: | |
| *Type of Organization: | |
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| NON-PROFIT ORGANIZATION INFORMATION |
| *First Name: | |
| *Last Name: | |
| *Non-Profit or Business Name: | |
| *Phone Number: | |
| *Email Address: | |
| *Address 1: | |
| Address 2: | |
| Address 3: | |
| *City: | |
| *Country: | |
| *Region: | |
| *Postal Code: | |
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| *Description of non-profit organization's general mission: |
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| *501(c)3 Tax-Exempt Status: | |
| 501(c) Number: | |
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| PROJECT |
| *Name of project: | |
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| *Description of project: |
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| *Description of how image(s) will be used: |
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| *Requested image ID number(s) and title(s): |
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| *Third-party rights (i.e., use of famous individuals) approved?* | |
| (*Note: Images depicting famous people, buildings, or brands may require additional permissions for advertising or commercial use. If you have already negotiated the necessary permissions, please let us know. We may request proof of permissions, upon donation.) |
| *Project timeline: | |
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