Permission Request Form

Permissions

Please use this form if you wish to seek permission to reproduce a work or part of a work by one of our clients.

Please note all permissions take up to six (6) weeks to process.

Source Work

Author

The author of the work you wish to reproduce

First Name

Last Name

Work

The name of the work you wish to reproduce

Range

Do you wish to use whole or part of the work?

Whole

Part

Quote

Copy and paste the material you wish to use or a description of the extract

Number of words/lines

The number of words (prose) or the line count (poetry) you wish to reproduce

Your details

Name

First Name

Last Name

Company name

(if applicable)

Website

http://

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your work

Title

The name of the work you will publish

Format

Printed book, eBook, website, article

Author/editors

Your name as it will appear on the work and any other authors or editors

Publisher

The publisher of the work (please indicate if self-published

Date of publication

Or best estimate

RRP

Recommended retail price of publication

Territories

Countries in which the work will be published

Print run

Approximate initial print run

Relevant information

Please include some contextual information so we can best consider your request. For example, what is your work about? How will the reproduced work be used?