Permission to Use Copyrighted Material Long form

AGREEMENT made by and between _________ a company or corporation with its principal offices at ________ City of ______ State of ___ Zip __ (hereinafter referred to as "Company"), its successors and assigns; and ________ whose address is __________ City of _________ State of ____ Zip __ and who is a citizen of _____________ (hereinafter referred to as "Author"), his [or her] heirs, executors, administrators, successors and assigns; do hereby agree concerning copyright material presently called:

(Insert brief description, 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:

(Define 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:

(Describe in detail)

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 written below.

"Author" "Company"

Name: Name:

Title: Title:

(Signed): (Signed):

(Witnessed): (Witnessed):

Date: Date:

Taxpayer ID: Taxpayer ID: