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Photocopy Request Form

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	Photocopy Request Form

First Name:

Last Name:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Contact Phone Number:

Fax:

E-mail Address:

Your Reference Number (if any):

Wiley product/title from which you'd like to photocopy:

Is this title a book or a journal?

If this title is a book, please provide the following:

Book's Primary Author or Editor:

Book's ISBN:

If this title is a journal, please provide the following:

Journal Month:

Journal Year:

Journal Volume:

Journal Issue Number:

Specific pages or range of pages or figure numbers you wish to copy:

Maximum estimate of the number of copies you'll need:

Name of Your University or Institution:

Course Name and Number:

Term:

Instructor's Name:

Is the book the required textbook for the class:

Please indicate any unusual circumstances regarding this request (such as you are the author of the requested material)

(Please note: Response will be sent via fax or mail, not by e-mail.)

John Wiley & Sons, Inc.
and Wiley-Liss, Inc.
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0101-201-748-6011 (Telephone)
0101-201-748-6008 (Facsimile)

John Wiley & Sons, Ltd.
Permissions Department
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United Kingdom
44-1243-770322 (Telephone)
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permreq@wiley.co.uk

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Rights and Permissions
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49-6201-606-280 (Telephone)
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49-6201-606-332 (Fascimile)
rights@vchgroup.de


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