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DAVID LACHAPELLE STUDIO

Artwork Usage Request

Requesting Party

News Article (print)

News Article (digital)

Book (print)

Book (digital)

Magazine Article (print)

Magazine Article (digital)

News Program

Documentary

Commercial Usage

Other

Name of Publisher*

Country/Region

Address

City

Zip / Postal code

Contact Name/Role

Website

Contact Email

Phone

Title of Book/Issue/Article/Program/Etc.

Artwork(s) Requested

File Size Requested

Brief Summary of how Artwork will be used

Distribution markets (ie: France/Italy/USA/ online)

Deadline for Requested Files

Additional Information (optional)

All Artwork by David LaChapelle is under copyright.

Usage of Artwork is subject to written approval by the studio and contingent upon fully executed Usage Agreement.

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