Sample Permissions Letter

To Whom It May Concern:

Publisher’s name is planning to publish my book entitled Title of Book, in [Month, year]. The approximate length of this title will be # of pages pages, and the approximate list price will be $____.00 for hardcover and $___.00 for paperback.

I would like permission to reprint [cited text or image to be reproduced] by [author] from [title or source] in my book.

I ask that this permission include nonexclusive publication and selling rights throughout the world in all languages and in all editions, hardcover, paperback, and electronic, including reprints by ___________________ is or by other publishers licensed by the ___________________ is, and in any print and online advertising materials promoting this book.

I ask you to consider that distribution of our title outside North America and Europe will be minimal.

Since ___________________ occasionally receives requests for images to accompany a review of the book, I ask permission to reproduce the image(s) in book reviews or to accompany televised interviews. Any images used in reviews or to accompany author interviews will be properly credited.

Since ____________________ may receive requests from nonprofit organizations to make special editions such as Braille editions, large-type editions, subscriber disk recordings, and so on, for use by blind or partially sighted students, will you please extend your permission to allow ________________________ to permit these nonprofit organizations to make special editions of our title without further permission from you? Full credit will be given to the source.

If you wish to specify the exact wording of the credit, please do so in your response.

If you are willing to grant permission, please sign the release form provided below and return it to me at [address]. Please feel free to contact me directly at [contact info] if you have any questions or concerns. Your prompt consideration of this request will be greatly appreciated.