Date
Publisher
Name of person or Permissions Department
AddressDear: Permissions Editor:
I am presently writing a book
[article, etc.] and would like permission to use some of your material from:
Name of book, magazine, etc.
Author
Date published
I would like to use [describe the material you want to use from their publication.]
Note: Make sure you include page number if text, and if a figure, figure number and page number. You can also
include a copy of what you want to use. The more specific you are the better. Make it easy for the publisher or copyright holder to find the material.
[use one of these versions]
This material will appear as originally published in the following book [article, etc].
This material will appear as originally published in the following book [article, etc.] presently being prepared for
publication.
This material will appear as adapted as shown in the following book [article, etc.] or [presently being prepared for publication]. Note: Provide an example of the adaptation. If your
publisher ends up making the adaptations, the editors will provide the appropriate notes indicating the changes.
Present working title
Author
Publisher and approximate publishing date.
[If you do not have a contract with a publisher, list prospective publishers and/or your agent. You can also provide brief information about
yourself, for example, previous published material.]
I request nonexclusive world rights, electronic rights, in all languages, and for all editions. If you are the copyright holder, may I have your
permission to use the above material in this book [article, etc.]? I will use the appropriate citations to acknowledge your publication. If you have a preferred form
of acknowledgment please let me know. I also understand you may charge a small fee for the use of the material. If you like, you can use this letter to grant permission. Enclosed is a self-address envelope.
Thank you for your consideration. I look forward to hearing from you.