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Business Address - City, State Zip Business Phone - Business Fax E-mail: - Website: Date SAMPLE PERMISSIONS REQUEST (Insert name if known), Permissions Editor Company Name Company Address City, State Zip
I am requesting permission to (choose one) This request includes all revisions, future editions, and ancillaries of such Work, and in customized and derivative works based upon such Work in all forms and media (print and nonprint, in whole or in part), including nonexclusive North American rights in all languages. (Name of Your Company) will give full acknowledgement to the (choose one) webmaster/ author/ artist/ photographer/ lyricist/ etc. if said information is submitted no later than (insert month/date/year). Please indicate below the credit line you wish to have used. Type or print the information to avoid any error in giving correct credit. For your convenience, a release form is provided below. Simply complete the necessary information and return this entire letter to my attention. Your response via e-mail, fax, or mail, with signature, must be received no later than (restate deadline). Thank you in advance for your prompt assistance.
Sincerely,
Your Signature I (WE) HAVE THE RIGHT TO GRANT PERMISSION FOR THE USE OF THE REFERENCE DESCRIBED ABOVE AND HEREBY GRANT SUCH PERMISSION. PLEASE USE THE FOLLOWING CREDIT LINES: ______________________________________________________ ______________________________________________________ ______________________________________________________ NAME and TITLE (please print) ___________________________ NAME (signature) _______________________________________ Business Name: _________________________________________ Business Address: _______________________________________ City, State Zip: __________________________________________ Business Telephone __________________ Fax: _____________ E-mail ____________________________ Website: __________ DATE ________________________________________________ |
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Friday, August 10, 2007