Date   ________________________ Firm   ________________________ Address   _____________________
School   ____________________________________________________ Address   ___________________________________________________ Telephone   _________________________________________________ Person making request  _______________________________________ To Whom It May Concern: We would like to request permission to copy the following copyrighted materials: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Number of copies to be made   _________________________________ Copy medium  ______________________________________________ Use of copies   ______________________________________________ Thank you for your cooperation.
	Sincerely,
PRODUCER'S REPLY Permission is hereby:   _______ granted.   _______ denied. Details:   (include fees, limitations, etc.) _______________________________________________________________ _______________________________________________________________ Signature   ______________________________________________ Title   __________________________________________________ Date   __________________________________________________