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2. Photographic images in the Collection of the Riverside Historical Museum may not be used without written consent of the Riverside Historical Commission and are limited to a single use for a specified purpose. Proper Credit of the reproduction must be acknowledged as follows: Riverside Historical Museum, Village of Riverside, Illinois. Images may not be reproduced with a resolution of less than 300 DPI. A charge is assessed for all photographic reproductions, and payment must be received in full at the time a request is made. Charges are based on the sum of two fees: a $50.00 Reproduction Fee AND a one-time $50.00 Use Fee.
4. Requester Name
5. Title
7. Institution or Company
8. Date
   Date
10. Address
12. City
13. State
14. Zip Code
16. Use
17. Author
19. Title of Publication
20. Publisher
22. Publication Date
    Publication Date
23. Image(s) Requested
25. Electronic Signature Agreement

    I have read the conditions specified above and agree to abide by the terms as set forth.
    
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature
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29. Print Only

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