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Permissions Template

Lizzie Case Posted by Lizzie Case, Digital Editorial Intern, Berrett-Koehler.

Permissions Template

Read about Permissions here.

Date: _____________

To: _____________

From: _____________

I am preparing a manuscript to be published by Berrett-Koehler Publishers, Inc. that is tentatively entitled: ______________________________________________________

I write to request your permission to reprint/adapt/use [select one or more] the following material in this book as set forth below. Appropriate credit will be given as applicable.

Requested Material [include text or description of requested material here]:






Please indicate your agreement to this request by signing and returning to me one of the enclosed copies of this letter. The other copy is for your records.


I, _______________________, grant to the above-named author(s) and publisher and their licensees the non-exclusive worldwide right to use the requested material described above in the above-referenced book and in any subsequent editions or versions, foreign language translations or other derivative works of the book in any format or media, whether now known or later developed. I am fully authorized to grant the rights covered in this permission, and the requested material described above does not infringe upon the copyright or other rights of any third party.

Agreed to and accepted:

____________________________________ ____________________________________
Signature Name (printed) and Title (if applicable)

____________________________________ ____________________________________
Date Name of Organization (if applicable)

Read a note on forewords here.

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