Photocopy Service Request Form

All requests are $5.00 per article, plus $.20 per page for articles over 20 pages. All incomplete requests will be returned. Payment is due by check payable to SUNY IFR 900-401-04, State or Research Requisition, or cash or credit card payable at the Office of the Bursar. NOTE: Requests will be processed as submitted. The Copy Service is not responsible for errors in citations.

NAME_______________________________________________________________

ADDRESS____________________________________________________________

PHONE_______________________ E-MAIL ____________________________

JOURNAL TITLE____________________________________AUTHOR_______________

VOL___________DATE_______________PGS________________________

BOOK CHAPTERS/PARTS

AUTHOR/EDITOR________________________________________________________

TITLE_______________________________________________________________

PUBLISHER__________________________________________________________

PLACE OF PUBLICATION______________________________________________

DATE OF PUBLICATION______________________________________________

CALL NUMBER (IF KNOWN)__________________________________________

Please read and sign below:

WARNING CONCERNING COPYRIGHT RESTRICTIONS
The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted materials. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copyright infringement. This institution reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law.

I understand that the material I request may be subject to copyright restrictions (Title 17, U.S. Code). I hereby authorize SUNY Downstate and the Medical Research Library of Brooklyn to process all requests submitted and further agree to pay all charges incurred for the service.

Signature______________________________________ Date_______________________