Permission Letter for Planned Publication - Model

The following letter is a model, not a form letter. You must carefully examine your specific needs and modify the letter accordingly. It is also important to document your steps in the permission process. Keep good files!

[Date]

[Letterhead or Return address]

[Rights holder name and address]

Dear [Sir or Madam] [Permissions Editor] [Personal name, if known]:

I am currently putting together a manuscript for publication. I would like your permission to include the following material with this publication:

[Citation with source information]

This excerpt will be used in the following manner:

[Tell how it will be used/presented—such as tables, illustrations, photos, including your captions, etc. Also include why you are using this excerpt—what point(s) are you trying to make by using it?]

[It may be necessary to include another paragraph if your publication will also be electronically published—as is the case with many academic journals which publish online versions of their issues, either free to the public or password protected for use only by subscribers.]

The publication information is as follows:

[Title of publication]
[Document type-article, book, pamphlet, etc.]
[Publisher]
[Number of documents to be published in first printing]
[Intended audience]

Permission includes non-exclusive world rights in all languages to use the material and will not limit any future publications—including future editions and revisions—by you or others authorized by you.

If you do not control the copyright on all of the above mentioned material, I would appreciate any contact information you can give me regarding the proper rights holder(s), including current address(es). Otherwise, your permission confirms that you hold the right to grant the permission requested here.

I would greatly appreciate your consent to my request. 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.

Sincerely,

[Signature]

[Typed name]

Permission granted for the use of the material as described above:

Agreed to: __________________________ Name & Title: _______________________
Company/Affiliation: __________________ Date: ______________________________