Application form for digital reproductions of the Marciana NationalLibrary

To the Director of the Biblioteca Nazionale Marciana, Venezia

I, the undersigned ... ... ask for the following digital reproductionsto be realised at the expenses of ... ...

The reproduction requested is:

Author: ...
Title: ...
Call number: ...

Type of requested reproduction:

Resolution: ...
Size: ...
B/W or colour: ...

Type of electronic support:

floppy disc
CD-ROM
Internet

Type of operating system:

Windows 3.11
Windows 95
Mac OS
UNIX

Digital format:

TIFF PICT EPS JPEG GIF Other

Such reproductions will be used for the following purpose (study, culturalpreservation, to be annexed to graduation dissertations, publication ina volume, etc.): ... ...

Date: ... ...

Signature: ... ...