Permission to Reprint Published Material

PERMISSION TO REPRINT PUBLISHED MATERIAL IN NEW WORK

Dear {Copyright Holder},

I am writing a {novel, article, essay, etc.} that will be published by {publisher} on {date}. I am seeking your permission to reprint the following material:

{Title, Author. Edition. Publisher, Date.}

{Page numbers, description of material, lines of poetry, beginning and ending quotations, or full excerpt}.

The material has been modified in the following ways: {modifications, truncations, or text removals}. Credit will be listed as "adapted from" to indicate changes.

The material will be printed in {Title, Author. Edition. Publisher, Date}. It will appear solely in this work (and subsequent editions/reprintings).

Credit will be listed as {Credit} {at the end of the material, in a footnote on the same page, in the endnotes, etc.}

Please fill out the release form below and return it to me at {address}. Or, feel free to contact me at {contact information}. Thank you.

Sincerely,
{Name}

I, ________________________________, the copyright holder of __________________, hereby grant ______________________________ one-time permission to use the aforementioned material solely in the capacity listed above. I understand that this permission is legally binding and non-revocable.

I grant my permission with the following conditions:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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_________________________________________
(Grantor Signature)

_________________________________________
(Date)

Index of Printable Contract Examples