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For permission to reprint portions of our clients’ works in English or in translation, fill out this form. You will receive a confirmation message and email with details how to follow up if necessary. If you do not, please follow up with permissions@cbltd.com, or by mail to: Curtis Brown, Ltd. Attn: [Name of Author] 228 East 45th Street Suite 310 New York, NY 10017
OUR TITLE/AUTHOR
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First Published In:
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Please list the page numbers, the edition, and the first and last sentences or lines of the requested material, or describe any images:
YOUR CONTACT INFORMATION
Your Name:
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Address
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Address Line 2
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Afghanistan
Albania
Algeria
American Samoa
Andorra
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YOUR PROJECT’S DETAILS
* If you are requesting rights for more than one format, please list the details for each format separately below.
Project's Title:
Project's Author
Publisher:
Description:
Format(s) of distribution (Please check all that apply)
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CD-Rom
Audio
Verbatim E-Book
E-book in a Database
Website
Other, Please explain
Other format explanation:
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Language:
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(If you are requesting rights for more than one (1) language, please fill out a separate form for each language)
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Estimated total print run/number of end users for life of project:
Estimated publication price:
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Term of license:
1 year
3 years
5 years
7 years
10 years
one time use
If you would like us to include your internal project ID on correspondence, please provide it here:
ADDITIONAL INFORMATION
Audio:
Please specify the mode(s) of distribution (i.e. CD, cassette, etc.)
Will the recording be single-voiced? If no please explain:
Will the recording be non-dramatic? If no please explain:
Website:
URL:
Will the posting be non-dramatic and non-interactive? If no please explain
Will the posting be password protected? If no, please explain:
Will the website be read-only or print-enabled? If print-enabled, please specify the estimated print run:
Database
Will the database be non-dramatic and non-interactive? If no please explain
Will the database be password protected?
Purpose of database:
educational electronic access
the creation of custom versions
other (explained below)
If other, please explain:
Is the database funded from sources other than the sales of individual copies of the work?
If your database creates custom versions, please list the formats of such versions:
Estimated number of total print run (above) that will be such derivative versions:
Any additional comments: