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 firstname.lastname@example.org. Alternatively, you can print this form and fax it to 206-467-4301 or mail it to the address above – Attention Permissions. Date submitted
Name Company / Affiliation
Address Phone number Fax number
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.