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Sample written request for permission

Permissions Department

Dear Permissions Editor:

I am writing to ask your permission to (include all that apply)

the following material:

Book Title:
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or material located at: [url].

The material will be distributed/published as follows:

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Expected length of work (number of words, pages, images, etc., as appropriate):
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If you do not solely control copyright in the requested materials, I would appreciate any information you can provide about others to whom I should write, including most recent contact information, if available.


  • Copyright proprietor, please initial any statement that applies:
    • I hereby represent that I have the authority to grant the permission requested herein.
    • I am the sole owner/author of the work.
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