Tract Permission Request Form

Name:
Email Address:	This is how we will follow up with you.
Address (street, city, state, zip, country):
Phone number:
Are you an individual or a company?
Company name:
Company website URL:

Select appropriate use:
How many copies will be produced?
For whom?
Provide URL:
Provide journal/magazine name:
Article title:
Length:
Check box if the journal/magazine will be sold:
Title of book:
Author:
Length:
What percentage does the requested quote make up of the work’s total text?
Check box if book will be sold:
Provide retail price:
Publishing plan:
Publisher name:	Publisher name is required to receive permission.
Expected publish date:	YYYY-MM-DD
Distribution channels and formats:
Provide detailed description of intended use:

Will the content be translated?
Into what language?