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Internet Requests
All requests should be submitted via mail to Random House, Inc., ATTN: Permissions Dept., 1745 Broadway, 15th Floor, New York, NY 10019 or by fax to (212) 572-6066. Please note that we do not accept initial submissions as e-mailed requests.
All
fields below must be completely filled out or your request will not be processed.
RANDOM HOUSE, INC. INTERNET REQUEST FORM
Date of Submission:
Information Pertaining to the Random House book you are quoting from:
Title:
Author:
Publisher/Imprint:
Copyright Year:
ISBN:
Selection or material you want to use (Please specify page number
and/or approximate number of words):
Information Regarding Your Project:
Name of webpage:
URL:
Publisher:
Territory:
Number of unique visitors/subscribers per year:
Online date:
Subscription fee:
Password protected:
( Y / N )
Language needed:
Requester Information:
*Also provide in the additional notes section below this same information for the contract signatory and/or the person responsible for payment if this differs from requestor.
Name:
Position:
Company:
Address:
City:
State:
Zip Code:
Country:
Phone:
Fax:
E-Mail:
If you would like to provide additional information or further explanation, please do so here:
Please allow a minimum of
8
weeks for a response.
Note: We do
not
expedite requests. All requests are processed in the order they are received.
