[Recipient Address]

[Date]

[Sender Address]

Dear ________________,

I am requesting permission to ______ [briefly describe the intended use of the work in copyright ]. 

This request is for permission to _____ [describe in detail the intended use of the work, the performance, the intent not to profit, how will it be distributed, how big is the audience, how much will it be reused, etc.].

I believe that your company is currently the holder of the copyright. If you do not currently hold the rights, please provide me with any information that can help me contact the proper rights holder. Otherwise, your permission confirms that you hold the right to grant this permission. 

This request is for a non-exclusive, irrevocable, and royalty-free permission, and it is not intended to interfere with other uses of the same work by your company. I hope that you will support our [not-for-profit performance] by granting this permission. I would be pleased to include a full citation to the work and other acknowledgement as you might request. 

I would greatly appreciate your permission. If you require any additional information, do not hesitate to contact me. If you agree with the terms as described above, please sign the letter where indicated below and return a signed copy to me. [Be sure to include your address and other contact info]

Sincerely,

[Sender’s Signature]
[Additional contact info – phone #, email address]