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["DEMANDE AU SERVICE DE REPROGRAPHIE"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SVP REMETTRE UN ORIGINAL ET UNE COPIE DU FORMULAIRE DÛMENT COMPLÉTÉ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DATE"]
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[null,"COURRIEL POUR L'ENVOI DE LA RÉQUISITION COMPLÉTÉE"]
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[]
[]
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["VENTILATION DE LA DÉPENSE"]
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[null,null,"UBR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"COMPTE",null,null,null,null,null,null,null,null,null,null,null,null,null,"FIN.",null,null,null,null,null,null,null,null,null,null,null,"UNITÉ ADM."]
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[null,"DEMANDE D'IMPRESSION",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NOMBRE D'ORIGINAUX",null,null,null,null,null,null,null,"NOMBRE   DE COPIES",null,null,null,null,null,null,"Mode",null,null,null,null,null,null,"Média",null,null,null,null,null,null,null,null,"Couleur",null,null,null,null,null,null,null,"Reliure",null,null,null,null,null,null,null,null,null,null,null,"Montant"]
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[null,null,"Fourniture / Service / Commentaires"]
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[null,"AU CENTRE DE REPROGRAPHIE:"]
[null,"Le demandeur s'est assuré que la présente demande respecte la Loi sur le droit d'auteur (1970, S.R.S., ch. C-30).  Il dégage l'École Polytechnique de toutes responsabilité pouvant découler de la reproduction demandée.  La direction de l'École Polytechnique vous rappelle, en particulier, que la reproduction d'une œuvre ou d'une partie importante d'une œuvre est prohibée par la Loi sur le droit d'auteur (1970, S.R.C., ch. C-30), à moins que l'autorisation écrite n'ait été obtenue à cette fin du titulaire des droits d'auteur.  La reproduction d'un court extrait d'une œuvre peut être faite aux fins suivantes: étude privée, recherche, critique, compte rendu ou résumé destiné aux journaux (utilisation équitable).",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOUS-TOTAL"]
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[]
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["SIGNATURE DU DEMANDEUR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RESPONSABLE DE L'UBR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SIGNATURE- SERVICE DE REPROGRAPHIE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ESPACE RÉSERVÉ - CENTRE DE REPROGRAPHIE"]
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[]
["À COMPLÉTER"]
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["DE POLYTECHNIQUE MONTRÉAL"]
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[]
["Utilisez-vous dans votre document:"]
["des figures, tableaux ou des extraits tirés d'autres ouvrages?"]
[]
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["Si oui, veuillez compléter le formulaire de déclaration des droits d'auteurs"]
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[null,"Signature du demandeur:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date:"]
[]
["N.B. Les formulaires sont disponibles:  aux secrétariats des département et services,"]
["au Centre de reprographie C-225, poste 4373 et aux Presses internationales Polytechnique B-528, poste 4473"]

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["recto"]
["recto/verso"]

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["papier"]
["papier glacé"]
["carton mat"]
["carton glacé"]

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["Noir/Blanc"]
["Couleur"]

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["Assemblées"]
["Brochées en coin"]
["Brochées à cheval"]
["Reliées spirale"]
["Reliées Wire-O"]