Reprint Request Form - DOC by a2302339

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									                          JohnTalk Reprint Request Form

Reprint Policy: All material in JohnTalk and JohnTalk Online is copyrighted and may
be reprinted only with permission on an article-by-article basis.

If you wish to obtain permission to reprint an article, fill out the following form.

After you have our written permission, please print this notice at the end of the reprinted
article:
         "Copyright ____ (insert year the article was published) by PolyJohn Enterprises
         Corporation, 2500 Gaspar Avenue, Whiting, IN 46394 (800) 292-1305. Reprinted
         by permission."

When we have received your request, we will quote you a fee (if applicable). After you
have agreed to the fee, you may proceed with the reprint and we will send you an invoice
at the beginning of the following calendar month. All invoices are payable upon receipt.

Please be advised that all permissions are for one time use.

Please fill out this form to receive permission to reprint articles from the PolyJohn
Enterprises. All fields are required.


REQUESTED ARTICLE
Headline of Article:
Author:
URL of Article:


CONTACT INFORMATION
Contact Name:
Organization Name:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax Number:
Email:
USAGE INFORMATION
Please specify the intended usage of the requested
material. If necessary, please include additional
information in the Other/Special Instructions section.
Newspaper:
 Circulation:
Magazine:
 Frequency:
 Circulation:
Book:
 Print Run:
 Distribution:
 Languages:
Classroom Distribution:
 Number of Students:
 Semester
 Course Name:
 Instructor:
Web Use:
 URL:


OTHER / SPECIAL INSTRUCTIONS
Please Describe:

Please return all Reprint Requests to PolyJohn’s marketing representative:

Sandra Flotow
Newcomb Marketing Solutions
605 E. 9th Street
Michigan City, IN 46360
Fax: (219) 874-3201
Phone: (219) 874-3201
Email: sandraf@newcombsolutions.com

								
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