DIY Legal Forms

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Permission To Use Copyrighted Material

(Type A)

AGREEMENT made on [Date] by and between [Name] a company or corporation with its principal offices at [Address], hereinafter referred to as "Company", its successors and assigns; and [Name] whose address is [Address], and who is a citizen of [Country], hereinafter referred to as "Author", his or her heirs, executors, administrators, successors and assigns; do hereby agree concerning copyright material presently entitled:

(Insert brief desciption, name, and title)

and hereinafter referred to as the "Article".


In consideration of the mutual covenants herein contained, the parties agree as follows:

1. Copyright. For good consideration, the "Author", as copyright holder, hereby grants permission to "Company", to reprint, publish and use for local and world distribution the following "Article":

[Full description]

This material shall be used only in the following manner or publication:

(Outline its intended use)

This agreement conveys all other rights back to the "Author". A credit line to acknowledge use of the material is [ ] is not [ ] (please check one) required. If required, the credit line shall read as follows:


2. Warranty. The "Author" guarantees that the "Article" has not previously been published elsewhere. Otherwise, the "Author" guarantees that if it has been previously published in whole or in part, permission has been obtained for publication in [Publication Name] and the "Author" will submit with his or her "Article" the exact wording of credit lines for such permission.

3. Reprints. Should the "Company" and its publisher receive any requests to reprint any or all of the "Author(s)" "Article", to be published in a reader or anthology, the "Author(s)" approval will be obtained and any fee charged by the "Company" divided equally between the Author" and the "Company".

IN WITNESS WHEREOF the parties hereto have executed and duly witnessed this Agreement as of the day and year first written above.





Taxpayer ID:





Taxpayer ID:

(Witnessed by:

This Section for Notary:


STATE OF -------)

) ss: [date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.


[Name of Notary Public]

My commission expires: [date]