Permissions Request Form
Request to reprint material from one of our Algonquin or Algonquin Young Readers books.
Date
Information about our book
Title
Author
ISBN
Detailed description of the material you’d like to reprint including page numbers from our book
Please include a photocopy of the material in context. (PDF only)
Information about your project
Usage Requested
Reprint
Copies
Course Pack
Other (explain below)
Usage Requested: Other
Title
Author
Publisher
Expected Date of Publication
Type of Format
Hardcover
Paperback
Electronic
Website
Expected print run (or copies needed)
If multiple formats, indicate the quantity of each.
Territory of distribution (e.g., US & Canada, World, etc.)
Language
List Price
Page Count
If the request is for a course pack, please specify the course and semester
Any other important information about your project
Requester Information
Name
Company
Street Address
Phone#
Email Address
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