Book Reprint Permission Request Form


  1. Your Information

  2. Contact Name:*
    Please enter your name.
  3. Affiliation:*
  4. Address:
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  5. City:*
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  6. State or Province (if applicable):*
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  7. Zip/Postal Code:
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  8. Country:
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  9. E-mail:*
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  10. Phone:
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  11. Fax:
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  12. Your Publication Information

  13. Title:
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  14. Author / editor:
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  15. Publisher:
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  16. Nonexclusive Market:
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  17. Anticipated Pub Date:
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  18. Format:
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  19. If material will be used in a database, please explain how access will be obtained. (Password protected, etc.)
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  20. If material will be used in a database, will you permit users to print, download, or e-mail? Please give details:
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  21. If material will be used in any other digital format please explain:
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  22. Number of pages in your publication:
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  23. List any translation rights requested:
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  24. Number of copies in each format:

  25. Cloth copies:
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  26. Cloth Copies (sold with e-book):
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  27. Paper:
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  28. Paper copies (sold with e-book):
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  29. Estimated lifetime copies Ebook (if sold separately from print edition):
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  30. Number of Database subscribers:
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  31. List price of each format:

  32. Print cloth edition:
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  33. Print cloth (sold with ebook:
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  34. Print paper (sold with ebook):
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  35. Print paper edition:
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  36. eBook (if sold separately from print edition):
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  37. Database subscription:
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  38. UT Press Book Information:

  39. Book Title:
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  40. Author / editor:
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  41. Chapter:
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  42. Pages:
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  43. First and Last sentences
    of quote:
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  44. Photo, figure, map, or table numbers:
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  45. Please explain how the requested material will be used:

  46. Use:




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  47. Explain:
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  48. Permission Contact Information

  49. Please indicate to whom a permission and/or invoice should be addressed:
  50. Publisher:
  51. Contact Name:
    Please enter your name.
  52. Address:
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  53. City:
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  54. State or Province (if applicable):
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  55. Zip/Postal Code:
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  56. Country:
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  57. E-mail:
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  58. Please help us contain spam by entering the four characters below. Then click submit!
  59. Thanks!
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  60.