[Date] [Letterhead Or Return Address] [Rights Holder Name And

[date] [letterhead or return address] [rights holder name and address] dear [sir or madam] [permissions editor] [personal name, if know

[Date]
[Letterhead or Return address]
[Rights holder name and address]
Dear [Sir or Madam] [Permissions Editor] [Personal name, if known]:
I am in the process of creating [Describe project]. I would like your
permission to include the following material with this [Project]:
[Citation with source information]
The [Project] will be used [Describe how the project and material will
be used]. It will be accessible by [Describe users].
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.
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.
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:
(This letter was modified from a sample created by the IUPUI Copyright
Management Center. View the original letter [http://www.copyright.iupui.edu/ppublication.htm])