BHC Press Permissions Request Form

BHC Press Permissions Request Form
Your Contact Information
Name *

First Name Last Name
Address *

Street Address

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City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
BHC Press Title Information
Author *
Title of Book *
ISBN *
Include text excerpt you are requesting permission to use in this box. *
Page Number(s) Where Excerpt Is Located *
Approximate Word Count of Excerpt *
Where will the excerpt be used? *
If excerpt will be used in a print or ebook also provide the following information
Publisher
Expected Publication Date
Book Format(s)
Print Run or estimated total copies through print-on-demand
Price
Page Count
If ebook only, what is desired length of license? (Typically 5 years)
Additional Information
Please do not submit any requests for images or photographs. We do not grant that type of permission request.
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