Sample Permission Request Blank
Author: We suggest that you have a letter similar to this made up on your own headed stationery; complete
the relevant details; and send in duplicate to the copyright holder. If applicable, you also may have to send
a letter to the author of the work in which the material was published previously.
To:
Copyright Permission Department
Date:
Copyright Permission Request
I am preparing a manuscript for a work entitled Science and Application of Nanotubes
edited by David Tomanek & Richard Enbody
to be published by Plenum Publishing Corporation. I would greatly appreciate your
permission to use material from your publication as specified below/in the attached.
Title:
Author:
Year of publication:
Material for which permission is requested:
Credit will be given to the source.
Two copies of the request are enclosed. Please return one and retain one for your records.
Signed:
Name:
We hereby grant permission for use of the material as specified above.
Signed:
for the copyright holder: