[Your address]
[Date]
[Publisher Address]
Dear [Copyright Holder]
I am preparing for publication an article entitled [title] to be published by [publisher]
in the [journal title].
I would greatly appreciate permission to include the following material:
Author: [Name of author(s) or editor(s)]
Publication: [Book or journal title; URL]
Chapter: [Chapter number and/or title]
Page(s): [Page number(s); direct hyperlink]
Description: [Figure or table number, image title, or number of words]
I am requesting non-exclusive rights world rights in this edition in all print and
electronic formats in perpetuity. This will not limit any future publications by you or
others authorised by you. Full acknowledgment will of course be given to the source.
If you do not have the necessary rights, please could you indicate who might be in a
position to give this permission? Please also let me know if you have any particular
citation requirements.
If you require any additional information, please do not hesitate to contact me. I can
be reached at:
[Your contact information]
A duplicate copy of this request has been provided for your records. If you agree with
the terms as described above, please sign the release form below and send one copy
with the self-addressed return envelope I have provided.
I look forward to your reply. [If you have a deadline, say so here]
Yours sincerely
[Signature]
[Your name]
Please could you indicate your agreement by completing and signing a copy of the
below form and returning it by post.
_______________________________________________________________
Permission is hereby granted for the use of the material described above.
Signed ______________________________________
Title ________________________________________
Company / Publisher __________________________
Date ________________________________________
I (WE) HAVE THE RIGHT TO GRANT PERMISSION FOR THE USE OF THE
MATERIAL DESCRIBED ABOVE AND HEREBY GRANT SUCH PERMISSION.