Customer Service

Online Permissions Request Form

To request permission to use copyrighted material, fill out the form below in its entirety. Please allow ample time for a response. If possible, we will fax back a response.

* Required fields
Requestor Information
* First Name
* Last Name
School/Organization
* Address 1
Address 2
* City
* State/Province
* Zip Code (##### or #####-####)
* Country
* Phone Number (###-###-####)
Fax
E-mail (Ex. john@hmco.com)
Additional Comments
Material Requested
Title of Book
Other (Ex. CD-ROM, Web site)
Author(s)/Editor(s)
ISBN (Ex. 0-123-12345-1)
Copyright Year (Ex. 2005)
Page Number(s) Being Requested
Description of Material Requested
Description of Use
How will the material be used?
In what format? Photocopies
Web site
Large print for the visually impaired
Other (specify)
What are you reproducing? Text only
Art only
Text and Art
If photocopies, how many copies of each page will you reproduce?
If Web site, type the URL of site where material will be used
Is this Web site password protected? Yes
No

"In other publication" Information
Title of Your Publication
Author's/Editor's Full Name
Publisher
Binding Format Hardcover
Softcover
Audiotape
Audio CD
CD-ROM
Web site
Other
 
Estimated 1st and Lifetime Printing Quantities
Publication Date (Ex. MM/DD/YYYY)
Proposed List Price
Estimated Number of Pages
Rights Sought US only
North America
World
Other  
Language English
Spanish
Other  
Market Elementary School
Secondary School
College
Trade
Custom Publishing
Other  
Will any changes be made to our copyrighted material? No
Yes (If yes, please explain)
Will our material be re-illustrated? No
Yes
Requested Term of License 5 Years
7 Years
10 Years
Other  
Additional Comments