RE:  Request for Permission to Reproduce Image(s)

Dear :

I am writing to request permission to  described below the "Image(s)":

• Artist:
• Title: 
• Date:
• Medium:
• Dimensions:
• ID Number:
• Artist: 
• Title: 
• Date:
• Medium:
• Dimensions:
• ID Number:
• Artist: 
• Title: 
• Date:
• Medium:
• Dimensions:
• ID Number:
• Artist: 
• Title: 
• Date:
• Medium:
• Dimensions:
• ID Number:

I have already obtained a reproducible copy of the Image(s), and have enclosed a copy for your convenience.I would like to request a(n) of the Image(s) from which I can produce the Image(s) for the purposes described below.

The Image(s) will be used as follows: .

The Image(s) will not be used in a seminar or other educational activity. will be used in a seminar or other educational activity as follows: .

I hereby request nonexclusive worldwide rights, for this only. If you are not the copyright holder, or if permissions from other sources are needed to obtain worldwide rights, including rights in and to the reproducible copies or prints of the Image(s), please let me know and indicate the person or company to which such requests should be directed. I acknowledge that submission of this request does not constitute permission, and that any use of any copyrighted images owned by the copyright holder is unauthorized unless and until I have received a signed letter of permission or agreement. I further acknowledge that if any usage or administrative fees are assessed by the copyright holder, a signed letter of permission or agreement may be withheld until those fees are paid.