(the "Owner") has received the request of (the "Requestor"), in a letter dated to reproduce the Material (as defined below). The Owner grants the request on the following terms, and the Requestor agrees as follows:

1. The published work described below (the "Work") is the subject of this agreement:

  • Author:
  • Title:
  • Publication Name:
  • Date:

The Owner is the sole copyright holder of the Work.

2. The Owner hereby grants permission to the Requestor to use the following selection from the Work: (the "Material"). The Material represents approximately % of the Work. A copy of the Material is attached to this agreement as Exhibit A.

3. The Requestor may use the Material only as follows, without deletions from, additions to, or changes in the text: .

4. The Requestor may not use the Material in a seminar or other educational activity  without restriction only as follows: .

5. As consideration for the grant of the Owner's permission to use the Material, the Requestor shall pay to the Owner a one-time fee of (the "Fee"). The permissions granted under this agreement are ineffective until the Fee is paid in full.

6. This agreement provides nonexclusive  worldwide English language rights, for this volumeissueedition only.

7. Every copy of the Material used must include, either on the copyright page or as a footnote on the page on which the Material begins or, if in a periodical, on the first page of the quotation, the following credit line: . If the copyright and acknowledgment notices are not printed as specified, all permissions granted by this agreement are canceled without further notice.

8. The Owner makes no representations about the Requestor's use of the Material. More specifically, the Owner has not obtained any releases covering the Requestor's use of the Material and the Owner does not represent that the Requestor's use of the Material will not infringe the rights of any third parties. The Requestor shall indemnify the Owner against any claims, damages, liabilities, losses, or expenses (including reasonable attorneys' fees) that may arise out of the Requestor's use, reproduction, or distribution of the Material.

9. This agreement will terminate automatically if the volumeissueedition is not published within  years from the date written below. In addition, the Owner may terminate the agreement at any time on days' notice, or immediately if the Requestor does not comply with any term of this agreement.

10. On termination of the agreement, all rights granted under this agreement, including the Requestor's right to use the Material, will end. The Requestor shall promptly discontinue its use of the Material and may no longer reprint, publish, or distribute the volumeissueedition. However, the Requestor will have an additional years from the time the permission terminates within which to sell existing copies of the volumeissueedition.  However, if the termination of permission is caused by the Requestor's violation of any provisions of this agreement, the Requestor may not sell any additional copies of the volumeissueedition.

11. The laws of the state of govern this agreement (without giving effect to its conflicts of law principles).

12. The Requestor shall furnish to the Owner one complimentary copy or tear sheet for each publication, except motion pictures, in which the republished Material appear, on or before publication of the republished Material. If permission has been granted for electronic reproduction, the Requestor shall furnish the Owner with the internet or other electronic address at which the republished Material will appear.

13. Nothing in this permission conveys any intellectual property rights or other interests to the Material or Work, and the Requestor may not reproduce, distribute, sell, or transfer all or part of the Material or Work. The Owner retains its own right to publish the Material or Work, or to grant permission for others to publish the Material or Work. The permission granted in this release is neither severable nor transferable to a third party. Any attempted transfer is void and of no effect.


Each party is signing this agreement on the date stated opposite that party's signature. 



Attach copy of Material


Permission to Reprint Published Material - Free Template

Secure the copyright holder's permission to republish all or parts of their work with ease. A permission form to reprint published material helps lay out the material description and the usage terms.

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What's a permission to reprint published material?

Whether you want to republish an excerpt from a bestselling author's novel in your newspaper or a few illustrations from an artist's comic strip on your blog, you'll need the copyright holder's permission first. permission to reprint published material allows you to republish all or parts of someone else's published work.

Here's the information you'll need to have handy to complete your permission to reprint published material:
- Who owns it : Have their name and contact information ready.
- Who's requesting to use it : Have their name and contact information ready.
- What it is and how it will be used : Know what kind of work it is and how the requester plans to use it.