Application Form for Print Permissions | Society of Authors - Protecting the rights and furthering the interests of authors

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(Please apply separately for each author whose work you wish to reproduce)

a) Individual or company to be invoiced (if a fee applies)

Name: *

Address: *

Phone No: *

Fax No:

Email Address: *

b) Individual to whom formal letter should be sent (if different)

Name:

Address:

Phone No:

Fax No:

Email Address:

c) Details of the work in which the extract is to appear

Author:

Title:

Publisher:

Territory required:

Edition/s:

(eg hardback, paperback, book club, audio cassette, electronic)

Estimated print quantity of each edition:

d) Details of the extract you wish to reproduce

Author:

Title(s):

Number of words of prose:

Number of lines of poetry:

(please list each poem separately)

Language:

(if not English)

Word verification: * Type the characters you see in this picture.

Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.

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The Society of Authors is a company registered in England No. 19993 and an independent trade union. VAT registration number: 239542840

The Society of Authors, 84 Drayton Gardens, London SW10 9SB.

Telephone: 020 7373 6642