Book title and edition (example: 5/e) Date Copyright & Permissions      –or- Name of Person being contacted w/their title Address City, State, Zip code Attention: Name of Person, if known, otherwise, department name I am asking for permission to use the material identified on the attached form for the [hardcover/softcover] book Title, edition by [Authors' Names] b not been eing published by [Name of Publisher.] Permission was previously granted for Title edition. –or- Permission has not been previously requested. Please return the signed permissions form and/or license agreement to my attention no later than [date and year.] If you are not the correct contact, or if I also need to contact any other licensees, please let me know immediately. Thank you! Permissions, license agreements, and invoices should be MADE OUT TO: Company/Requestor Name Note: This is the name of the company or individual paying for the permission. Xxxx Xxxx, Title Address City, State, Zip code Note: If you are gathering permissions for someone else, include the following, If the payee and mail contact are the same, this can be omitted. But! All correspondence and agreements should be MAILED DIRECTLY TO ME: Your name     Your phone: Your address     Your fax: Your city, state, zip code     Your e-mail: I sincerely hope you will grant your permission. Please indicate your approval by signing and returning either the attached form or your own agreement form to my office by fax , mail, or e-mail attachment no later than [repeat date, year] Reminder: License Agreements should be made out to Name of Company. Sincerely, On behalf of Company Your Signature Permissions Request Please reply no later than [Date] (same as on cover letter) Send correspondence and/or replies to: License Agreements & Invoices should be made out to: Your name Company paying fee Your address Attn: Editor's name Your city, state, zip code Editor's Address Your phone: Editor's City, state, zip code Your fax: Editor's phone: Your e-mail: Editor's e-mail: Permission Requested for: Title: Book Title and edition Authors: Author's Names First Print Run: # of books being printed initially  Anticipated Sales: total # of books (estimate) Format: [College textbook, novel, or..] [hard/softcover] Estimated No. of Pages: Rights Requested: Non-exclusive [World/- North American – U.S. & Canada] [ print rights – electronic rights – blog rights – x rights] in English [or appropriate language] for all editions, including revisions, ancillaries, and non-profit editions for the sight-impaired         NOTE: Verify with your editor above information and what rights are needed. Ask for everything knowing you probably won't get everything. Estimated Selling Price:   $$$ Estimated Publication Date: Month, Year Your Copyrighted Material Title: Title of book where excerpt was taken Author(s):   Originally Published: Complete as much info as known Excerpt to be used: Quote excerpt or in some way identify material being used         Note: If possible, include an exact copy of what's being quoted. Please indicate acknowledgement to be used. I hereby grant permission to [name of firm/person needing permission] for the material listed above. By signing this letter I warrant that I am the sole owner of the copyright, entitled to grant permission to use this material and in so doing, am not infringing on the rights of any other person or entity. If I am not the sole owner, I have notified [name of firm] and have provided contact information. Signed: ____________________________________Date: _____________ Your Name & Title (PLEASE PRINT): _____________________________ Company (For Publisher/Periodical/etc.)_____________________________ Address: ____________________________________________________ City/State/Zip: _______________________________________________ phone: ________________________ fax: _________________________ [ ] gratis [ ] Fee _____________ Payable to: ________________________                                              Tax ID: __________________________

To send a private message… Click HERE

081007 Thursday, September 03, 2009