Request Form for Permission to Reprint

Barcelona Publishers

REQUEST FOR PERMISSION TO REPRINT

 

Please fill out this form for each request and email to: stevens@barcelonapublishers.com 

I am requesting rights to reprint or reproduce the following material copyrighted by Barcelona Publishers: for worldwide distribution and for all reprints and revisions of my book or article.

 

Your book or article:

Title of chapter or article:

Title of book or journal:

Language of publication:

Total # pages of article or book:

Publisher:

# Copies to be printed:

Price per copy:

 

Barcelona material to be reprinted or reproduced:

Title of Barcelona Book:

Author:

Material to be reprinted or reproduced:

Text:     From page #                                   To page#

Beginning at the phrase:                                          

Ending at the phrase:

Total Number of words:

Illustration/Figure/Table/Photograph:

              Designated #

              Page #

Your Name and Mailing Address:

Name:

Mailing Address:

City                                                                               State                                                Zip

Email:                                                                           Telephone:

 

Disposition

 

_____Barcelona Publishers grants permission as specified above at no cost.

_____Barcelona Publishers grants permission as specified above for the cost of_______

_____Barcelona Publishers does not grant permission as specified above.

NOTE: If permission is granted, the following acknowledgment must be made in the anticipated publication:

Reproduced by permission of Barcelona Publishers.

Signature of officer:

 

________________________________                                ____________

Demi Stevens                                                                  Date