Return Completed Request Form To

Copyright Permission Request Form

❶Instructions

Use this form to request permission to reproduce or reprint more than one (1) copy of Association, AICPA, or CIMAcopyrighted material – either from print copies or published on the organizations’ web sites.For permission,

1. Complete this form. Please include all information that applies to your specific permission request.
2. Return completed request form to:
3. Within ten (10) business days, you will receive a Permission Agreement form (or refer you to the proper copyright holder in cases where wedoes not hold copyright).
4. Once you have returned the Permission Agreement agreeing to the terms and conditions, you may reprint immediately if necessary to meet a deadline.
5. If a fee is charged on the Permission Agreement form, an invoice will be sent to you within approximately two (2) weeks.

❷ Contact Information

Full Name: / Click here to enter text. /
Organization: / Click here to enter text. /
Address: / Click here to enter text. /
Telephone: / Click here to enter text. / Facsimile: / Click here to enter text. /
Email: / Click here to enter text. /

❸ Association/AICPA/CIMA work which you wish to reprint/reproduce

☐Article
(including website) / Work Title(s): / Click here to enter text. /
Author(s): / Click here to enter text. /
Copyright Year or Date of Issue: / Click here to enter text. /
Specific page(s), paragraphs/sections, or images as appropriate: / Click here to enter text. /
☐Book / Title: / Click here to enter text. /
Author(s): / Click here to enter text. /
Copyright Year or Date of Issue: / Click here to enter text. /
Specific page(s), paragraphs/sections, or images as appropriate: / Click here to enter text. /

❹Purpose of Reproduction/Reprint

Material will be used as follows:

☐College or University Class Handouts / Name of Class: / Click here to enter text. /
Institution: / Click here to enter text. /
Instructor’s Name: / Click here to enter text. /
Semester: / Click here to enter text. /
Number of Copies: / Click here to enter text. /
☐Conference Handouts / Conference or Professional Course: / Click here to enter text. /
Session Title: / Click here to enter text. /
Date(s) Held: / Click here to enter text. /
Sponsoring Organization: / Click here to enter text. /
Number of Copies: / Click here to enter text. /
☐ Reprint in publication / Title of publication: / Click here to enter text. /
Author: / Click here to enter text. /
Publisher: / Click here to enter text. /
Publication Date: / Click here to enter text. /
Initial Print Run or Circulation Size: / Click here to enter text. /
What our Content will comprise: / Pages or % of proposed publication
Please explain proposed purpose: / Click here to enter text. /
☐ Other:

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