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Permissions Request Form

Submit Your Request via E-mail

Written permission is required to reprint or reproduce material from any Visible Ink Press book. Complete the form below. All fields must be completed in order for us to consider permissions use. Please allow 4-6 weeks for processing.

Title of Visible Ink Press Book:*

Edition:*

ISBN:*

Copyright Year:*

Author Name(s):*

Print Run:

Product Price:

Title of Chapter(s) Requested:*

Page Number(s):*

Total Word Count:

Rights Requested:*

US only
North America
World

Profit/Non-Profit:*

Profit
Non-Profit

Binding:

Hard cover
Soft cover

Target Customers/Audience:

Format for which permission is requested:* (check all that apply)

Advertisement
Audio
Broadcast
Brochure
CD-ROM
Dissertation
DVD
E-mail
Framing
Journal/Magazine
Linking
Newsletter

Newspaper
Online Database
Other book
Pamphlet
Presentation/Handout
Promotional Material
Text Book
Trade Book
Video
Web Site (Intranet)
Web Site (Internet)

Purpose of Use:*

(classroom, seminar, office, etc)

Additional information required for Classroom,/Photocopying/Coursepacks, etc.:

Course Name:

Course Number:

Number of Copies:

Number of Pages:

Length of use:

Start of Term:

Your Full Name:*

Company/Institution:*

Address Line 1:*

Address Line 2:

City:*

State/Province:*

Zip/Postal:*

Country:*

Telephone:*

Fax:

E-mail:

Web site:

Notes:

Please note: Should permission be granted, it is subject to the full and timely payment of the administration fee.