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Application Form for Print Permissions

(Please apply separately for each author whose work you wish to reproduce)

a) Individual or company to be invoiced (if a fee applies)

Name

Address

Phone no

Fax no

Email address

b) Individual to whom formal letter should be sent (if different)

Name

Address

Phone no

Fax no

Email address

c) Details of the work in which the extract is to appear

Author

Title

Publisher

Territory required

Edition/s

(eg hardback, paperback, book club, audio cassette, electronic)

Estimated print quantity of each edition

d) Details of the extract you wish to reproduce

Author

Title(s)

Number of words of prose

Number of lines of poetry

(please list each poem separately)

Language

(if not English)