Explanation and Guide Form: Explanation: Copyright Permission Form for Use in Book This is a sample form for obtaining the permission to use copyrighted information in a book. It is to be used for permission to use a small amount of work.
____________________ ____________________ ____________________
Re: Copyright Permission
Dear _____________: I am in the process of writing a book on the subject of ________________, for publication. The book is tentatively entitled “_____________________” and is expected to be published by [publisher]. I request your permission to include the following items in my book for which I believe you hold the copyright: 1. 2. [Describe] [Describe]
I request irrevocable, perpetual royalty-free, non-exclusive rights to use and include such materials for my book and any revisions, translations or update to the book. I will acknowledge you as the author and copyright holder of the above referenced work. If this is acceptable to you, please sign and return to me a copy of this letter. Sincerely,
Permission Granted As Requested Above
Signature of Copyright Owner