Gallery One Art Loan Form

RECEIPT OF ARTWORK PLACED ON LOAN WITH COUNTY OF LOUDOUN GOVERNMENT
Artist/Lender Information
Are you the artist or lender?
Artist Name*

First NameMiddle NameLast NameSuffix
Artist Address*

Street Address

Street Address Line 2

CityState

Zip Code
Artist Phone Number*
Artist Email*
Lender Name*

First NameMiddle NameLast NameSuffix
Lender Address*

Street Address

Street Address Line 2

CityState

Zip Code
Lender Phone Number*
Lender Email*
Upload one image (front and back) of each piece on loan. Label each photo: artistlastname.artistfirstname.title.medium.front or back.jpeg*

10MB max in zip, jpg, jpeg, png, or tiff format. Lender agrees to allow the County to photograph the artwork and release photos to the media.
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Upload your image inventory. Each inventory must include artist name, title, medium, dimensions, year made, value, and condition description for each piece.*

pdf, doc, docx, xls, xlsx, or csv format only
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Terms of Loan Agreement

Date of Loan
Start Date*

DayMonthYear
Date
Delivered by Signature*

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End Date*

DayMonthYear
Date
Picked up by Signature*

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Loudoun County Art Exhibit Entry and Release Form

I understand that the County of Loudoun cannot guarantee my safety, or the safety of my property while it is on display. In compliance with Loudoun County policies for displaying my property, I have specified the title, size, medium, dimension, value, and condition of my property as listed above in my inventory form.

I hereby release the County of Loudoun, the Board of Supervisors, agents and servants and employees from any and all claims, injury and property damage which I may hereafter have, or claim to have, arising out of the display of my property.

I also understand that the County of Loudoun carries Exhibition Arts Floater insurance that insures an exhibit up to $100,000. For coverage to apply, I must submit to the County an inventory of items in the exhibit with the values listed for each item. I am aware that I am responsible for the deductible of $250 if and when a claim is filed.
Should be Empty:

RECEIPT OF ARTWORK PLACED ON LOAN WITH COUNTY OF LOUDOUN GOVERNMENT

Artist/Lender Information

Terms of Loan Agreement