Cornell University Press Permission Request Form
Sage House, 512 East State Street, Ithaca, New York 14850
Fax (607) 277-2374 |
Step 1. Complete 1, 2, and 3 in this section and return the form by email or fax. Use a separate form for each request.
1. Requestor's Name: Date:
Address:
Email: Telephone: Fax:
2. I wish to use the following Cornell University Press material [if the selection is to be edited, even only for length, fax a copy of the selection as it appears in Cornell's book and show all edits to be made]:
Title: ISBN:
Author/Editor: Publication Year:
Selection (page numbers, total no. of pages, approx. word count):
3. The selection will be reprinted in my publication:
Title: Publication Date:
Author(s): Publisher:
Format(s): Print Run(s):
Territory [e.g., US, world]: List Price(s):
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STEP 2. For completion by Cornell University Press
A. We do control rights to this selection and permission is granted on the following conditions:
· Nonexclusive, English-language rights in [territory], for inclusion in
this edition only of your publication in [format(s)].
· Payment of a fee of US$ , in US dollars by check drawn on a US bank and made payable to Cornell University Press (tax ID no. 15-0532082). This completed form must accompany your payment; we cannot process your payment without it.
· Inclusion of an acknowledgment line, in essentially the following form (please fill in the variables):
"From [full title and subtitle of our book], by [author/editor/translator]. Copyright © [year] by Cornell University. Reprinted by permission of the publisher, Cornell University Press. All rights reserved."
B. We do not control rights. You must request permission from
Signed, Stephanie L. Munson, permissions coordinator
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STEP 3. Indicate your acceptance or rejection of these terms by signing below. Keep a copy of the completed form for your records and return the original to Cornell University Press.
Agree: I accept the terms and enclose payment (if applicable):
Decline: I will not use the material: