Form D03501 1 Explanation and Guide Form: Request for Permission to Use Copyrighted Material Purpose: This is a sample letter requesting the right to use copyrighted material from a copyright holder. The text in red and sections underlined in red indicate terms that will be unique to the particular circumstance (e.g. names of companies). 1 [date] [name and address of copyright owner] Re: Permission to Use Copyrighted Material Dear [Name of Copyright Owner]: We are contacting you because you are the author of [copyrighted work] and we would like to [reprint or use] the [article, work, etc.]. We are in the business of __________________________. We plan to limit our use of your material to _________________. We will not use it in any other way. We respectfully request your support as the copyright holder to allow us the right to use the [article, work, etc.] free of charge in the manner described herein. If this is acceptable, you can simply sign and return to us a copy of this letter. Thank you for your consideration and your time. Sincerely, [Name] By: ____________________________ Title: ___________________________ Permission is Hereby Granted Pursuant To the Terms and Conditions of this Letter [Copyright Owner] By: ____________________________ Title: ___________________________