SAMPLE REQUEST FOR PERMISSION TO COPY

[Date]

[Address of copyright holder]


Dear Sir/Madam:

I would like permission to [describe the materials you want to use].
 
Title:

Copyright:

Material to be duplicated:

Type of reproduction:

Number of copies:

Type of use:


A self-addressed stamped envelope and a copy of this letter for your files are enclosed.
Please let me know what conditions, if any, apply to this use.

Sincerely,
[Your name, address, department, etc.]


Permission granted: __________________________ ______________
                    Signature                  Date
 
Conditions: ____________________________________________


__________________________ _____________
Signature                  Date