Request For Permission To Reprint Published Material

Document Overview

This is a fillable request for permission to reprint published material. Click any blank field in the document below, type your information, and your entries will autosave in your browser. Use the toolbar at the top to print, save as PDF, or download a completed copy. Below the form, you'll find a guide to using this document, common mistakes to avoid, and answers to the questions we hear most often about request for permission to reprint published material.

RE:  Request for Permission to Reprint Published Material

Dear Contact Name :

I am writing to request permission to reprint the Material (as defined below) from the following publication:

• Author: Author's name
• Title: Title of work
• Publication Name: Publication name
• Date of Original Publication: Date

I intend to use the following selection from the original published work: Description the "Material". The Material represents approximately Percent percent of the original published work. I have enclosed copies of the Material with this letter for your convenience.
Yes / No

The Material will be used as follows, without deletions from, additions to, or changes in the text: Description .Yes / No

The Material will not be used in a seminar or other educational activity.

Yes / No
Volume / Issue / Edition

I hereby request nonexclusive worldwide English language rights, for this Material Desc Material Desc Material Desc Type of publication only. If you are not the copyright holder, or if permissions from other sources are needed to obtain worldwide  rights, please let me know and indicate the person or company to which such requests should be directed.

I acknowledge that submission of this request does not constitute permission, and that any use of any copyrighted text owned by the copyright holder is unauthorized unless I have received a signed letter of permission or agreement. I further acknowledge that if any usage or administrative fees are assessed by the copyright holder, a signed letter of permission or agreement may be withheld until those fees are paid.