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Permission 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. PERMISSION REQUEST FORM
Date of Submission:
Information Pertaining to Our Book:
Title:
Author:
Publisher/Imprint:
Copyright Year:
ISBN:
Selection or material you want to use (Please specify page number
and/or approximate number of words):
A photocopy of the material in context must be provided.
Information Regarding Your Project:
Title:
Author:
Publisher:
Territory needed:
Language needed:
Please choose the applicable format(s) and fill in the pertinent information. If the formats below do not apply, please fill in the empty line with your desired format. *For print on demand titles, please provide an estimate as to the number of books that will be sold.
Hardcover Format
Price:
Print Run:
Publication Date:
Page Length:
Softcover Format
Price:
Print Run:
Publication Date:
Page Length:
Format needed:
Price:
Print Run:
Publication Date:
Page Length:
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.
