* Requester Name:

Organization:

• Nonprofit
• For profit

Organization's purpose:

Address 1:

Address 2:

City:      State:      ZIP:

Phone (h):

* Phone (w):

Fax:

* E-mail address:

I am requesting permission to nonexclusive rights to reprint the Bookhaven Press LLC material described below:

Publication title: (List book title and edition, web site address, etc.)

Publication date:

Title of article (if applicable):

Author(s):

From page: To page

Total # of pages

Publication Information:

I am requesting nonexclusive North American rights in the publication's original language to reprint the above-named Bookhaven Press LLC material as follows:

My publication name: (Pubication or promotional piece title)

Format of publication (e.g., book, newsletter, overhead, Web page, audiotape)

Purpose of publication:

Target audience:

Project will be sold Yes    No

Subscription rate/unit price: $

Estimated print run/circulation:

Estimated publication date:

* I will cite the following credit line:

From [Publication Title or Web Site Address (URL)], by [Author], © [copyright year]. Used with permission from Bookhaven Press LLC. All rights reserved. (The author must be included when quoting from a BLOG article. If the excerpted material is from a web site, other than our Blogs, no author annotation is required.

I am using Bookhaven Press LLC material exactly as it appears in the original publication

or

I would like to adapt the text of Bookhaven Press material. (If so please send a copy of the material as it will appear in your publication to: Reprint Coordinator, Bookhaven Press LLC, 249 Field Club Circle, McKees Rocks, Pa 15136.)

* A copy of any promotional piece using our content must be sent to Bookhaven Press LLC, 249 Field Club Circle, McKees Rocks, Pa 15136 or sent as an attachement to an email message sent to bookhaven@aol.com. If the material is used for a website the requestor agrees to notify Bookhaven Press LLC via an email to bookhaven@aol.com of the exact web site URL where the material resides.   

Please allow 7 to 15 business days for a response. If more information is needed or special arrangements are required, additional time may be needed to process your request. Call 412-494-6926 to check on the status of your requst.