Department for Culture, Media and Sport 
Government Art Collection 
Old Admiralty Building, Admiralty Place, 
London, SW1A 2BL 
Email: gac@dcms.gov.uk 

IMAGE REQUEST FOR PERSONAL USE (Form PS)

Order form for purchase of images for personal use or research purposes only
**NO REPRODUCTION PERMITTED**

I wish to purchase Photographic Material, as stated below, of the following work(s) in the Government Art Collection:

DECLARATION: In the event that you agree to accept this order and supply me with the Photographic Material listed above, I agree that:

1. I shall not make, nor shall I permit any other person to make, any reproductions from the Photographic Material; and

2. I shall use the Photographic Material and anything comprising the subject matter of the Photographic Material only for the purposes of my private study or research. Without any limitation to the foregoing, I shall not engage (either directly or indirectly) in any commercial exploitation of the Photographic Material or anything comprising the subject matter of the Photographic Material; and

3. I shall indemnify you against all claims, costs, damages, losses, or expenses which may be incurred by or brought against you as a result of any breach of any of the provisions of paragraphs numbered 1 or 2 above.

Your Details
Name and address of applicant: type answer here 
Telephone No: type answer here
Email address: type answer here
Purpose for which the image is required: type answer here 

Works of art required (delete or add rows as required)
Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here 

Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here 

Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here 

Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here 

Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here 

Artist: type answer here
Title: type answer here
GAC Inventory Number: type answer here
Purpose for which the image is required: type answer here