Permission 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: ______________

biz form courtesy www.businessownersideacafe.com