ermission Request for Use of Copyrighted Material
From (User) ____________________________________ ____________________________________ ____________________________________ To (Copyright owner) ____________________________________ ____________________________________ ____________________________________ Request to Reprint Copyrighted Material My company _____________________________ (User) would like your permission to reprint ________________________________________________________________________ ___ Purpose for Reprint We would like to print this information for _________________________________________ ________________________________________________________________________ ___ For your convenience, we have provided an authorization section below for you to grant or deny permission to reprint this copyrighted material. Please complete the section below and return to the mailing or email address above. If, however, your company has its own reprint permission authorization form, please send it at your earliest convenience for us to complete and return to you. Thank you for your time and attention regarding this request. Sincerely, _________________________________________________ Date __________________ Authorization to Reprint
Please check off your response to this reprint request: Copyright owner grants permission to ________________________________________ to reprint the indicated article for the stated purpose with no further action required. Copyright owner denies permission to ________________________________________ to reprint the indicated article for the stated purpose because: ________________________________________________________________________ ___ Copyright owner grants permission to ________________________________________ to reprint the indicated article for the stated purpose, only if they comply with the following requirements: User must place the following statement on the same page of the article: © ____________________________________ Reprinted with permission from _______________________________________________. All rights reserved. User must fax, mail, or email Copyright owner a copy of the reprinted material in its use for approval. In addition, User must __________________________________________ ____________________________________________________________ ____ Authorizing Signature: ____________________________________Date: ______________