Publishers Permission Request Form

Publishers Permission Request Form

Name

First Name

Last Name

Company/Organization

Street Address

Optional: Address (Floor, Building, Apt)

City

State

Postal Code

Country

Requestor Type

What material are you seeking copyright permissions for? (Please provide hyperlink if from website location)

Work in which the material will be used?

Credit line for material requested?

New code

Please type the code above

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