Reprint Permission Request Form

Please provide the information below to request permission to reprint a text passage or image from a Mazda Publishers book. Permission will be granted for only one print version of your publication and any other use requires additional permission.

I- YOUR CONTACT INFORMATION

Contact Name:
Affiliations:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:

II- MAZDA PUBLISHERS BOOK INFORMATION

Book Title:
Author/Editor:
Chapter and page numbers:
Photo, figure, map, or table numbers:

III- YOUR PUBLICATION INFORMATION:

Book Title:
Author/Editor:
Publisher:
Nonexclusive Market: [ ] World; [ ] United States; [ ] North America; [ ] Others.
Publication Date:
Format (cloth, paper, both, other):
Number of pages in your publications:
Print run of each edition:
List price of each edition:
If this is a translation request, which language will you be translating into?

Please mail or e-mail your request to:
Mazda Publishers, Inc.
P.O. Box 2603
Costa Mesa, CA 92628-2603
Phone: (714)751-5252
Fax: (714)751-4805
e-mail: mazdapub@aol.com


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