Puke Ariki - Museum, Libraries, Tourist Information

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 Image Order Form

 

I am aware of and accept the conditions laid down in the the guidelines for reproducing Puke Ariki images. I agree to use the image specifically for the purpose(s) described and I will pay processing and reproduction fees, which will be advised upon receipt of my order, as required. A copy of any publication using Puke Ariki images will be supplied for Puke Ariki's Collection.

   

Declaration
 

   

Your details  

   

Your Name  

   

Your Email  

   

Address  

   

Phone (day)  

   

Fax  

   

Order details  

   

First image  

   

Full details of intended use  

   

Date Ordered  

   

Image description  

   

Ref/Accession number  

   

No of copies  

   

Delivery method
 

   

Second image  

   

Full details of intended use  

   

Date ordered  

   

Image description  

   

Ref/Accession number  

   

No of copies  

   

Delivery method
 

   

Payment details  

   

Credit card type

 

   

Card Number  

   

Name on Card  

   

Expiry Date  

   

Additional details or comments  
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