Permissions Request Form

Permissions Request Form
Contact Information
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Phone Number
Please enter a valid phone number.
Permission Type and Medium
Type of Request
Classroom
Publication
Journal
Product
Other
Reference
Your reference
Classroom
University or School
Course Name
Instructor Name
Term
Number of Copies
Publication
Title of forthcoming publication/project
Title of article
Journal / periodical
Authors / editors
Publisher / manufacturer / distributor
Publication Date

MonthDayYear
Circulation
Hardcover

YesNo
Hardcover prices
Hardcover lifetime print run
Paperback

YesNo
Paper back prices
Paperback lifetime print run
Ebook

YesNo
Ebook prices
Ebook lifetime units
Website
Website traffic ( avg users per day and days available )
Territories

WorldNorth AmericaUnited StatesOther
Language
Audience
Additional information
Stanford University Press title information
Title
Authors / editors
ISBN*
Describe the material you want to use, including page numbers and chapter. Be as complete as possible.
Total number of pages
Please verify that you are human*
Should be Empty:

Contact Information