1904 Third Avenue, Suite 710 Seattle, Washington 98101 206.467.4300 fax 206.

467-4301

Permission Request Form - Reprint Use Please complete as much information as possible. We will evaluate your request only if all relevant areas are filled out completely. Please allow sufficient time for processing your request. We will send you an agreement with a usage fee quote once we have all relevant information. Please save a copy on your computer, fill it out, and return by e-mail to permissions@sasquatchbooks.com. Alternatively, you can print this form and fax it to 206-467-4301 or mail it to the address above Attention Permissions. Date submitted REQUESTOR INFORMATION Name Company / Affiliation Address

Phone number Fax number Email address Invoicing address, if not the same as above

THE SASQUATCH WORK YOU SEEK PERMISSION TO USE Title of Sasquatch book Author Illustrator / Photographer ISBN Copyright year Text to be used page number(s) indicate opening and closing words of passage(s) Illustrations / Photographs to be used page number(s) Any other information that will help us identify the material you would like to extract please be specific.

1904 Third Avenue, Suite 710 Seattle, Washington 98101 206.467.4300 fax 206.467-4301

INFORMATION ABOUT BOOK / MAGAZINE / WEBSITE / PROJECT IN WHICH EXTRACT IS TO BE USED Book / Magazine / Website title Author of work that would include extract Publisher Territory required for usage / Territory of distribution US Only Other Language English North America (please specify): All languages World

PUBLICATION INFORMATION please fill in all that applies to your project Proposed publication date Proposed publication price Proposed page count Format Hardcover Paperback Other (please specify): Hardcover: Paperback: Electronic indicate term of use: Other (please specify): Hardcover: Paperback: Electronic indicate term of use: Other (please specify): Textbook Anthology Other (please specify): Academic Electronic

Initial print run / Term of use

Anticipated total printing / Term of use

Type of publication (if book)

FOR OTHER MEDIA e.g. audio, electronic, broadcast, website Please give additional details if needed regarding terms of use requested.

Additional notes