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SECTION I. Contact Information:
SECTION II. Bill To Information:
If you would like your invoice to be addressed to a different recipient, please enter that information here:
SECTION III. Material to be Reproduced:
SECTION IV. Description of Your Proposed Product:
Please provide a general description of your proposed product (Description is limited 1000 characters):
SECTION VII. Acknowledgements and Signature:
I acknowledge that submission of this request for permission or receipt of a permission fee
quote does not constitute permission, and that any use of any copyrighted text or images owned by
APA or APP is unauthorized unless and until I am in receipt of a signed permission letter, electronic
product license agreement, or email.
I further acknowledge that my proposed use may be such that I may be required
to enter into an Electronic Product License Agreement in APA or APP's sole
I further acknowledge that if any usage or administrative fees are assessed by
APA or APP, the signed permission may be withheld until such fees are paid.
Please ensure that the form is completed in its entirety. Incomplete forms may delay processing of your request.