REQUEST FOR PERMISSION TO REPRINT PUBLISHED MATERIAL
[Your Street Address] [City, State, and Zip Code] [Insert Date]
Copyright Permissions Department [Publisher’s Name] [Publisher’s Company] [Publisher’s Address] [Publisher’s City, State, and Zip Code]
RE: Request for Permission to Reprint Published Material Dear ___________________: I am writing to request permission to reprint the Material (as defined below) from the following publication: Author: Title: Name of Publication: Date of Original Publication: I intend to use the following selection from the original published work: ________________________________________________________________________ ________________________________________________________________________ _____________________________________________________________________ (the “Material”). The Material represents approximately _________ % of the original published work. [I have enclosed copies of the Material with this letter for your convenience.] The Material will be used as follows, without deletions from, additions to, or changes in the text thereof: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________________________________________________