Permissions-form

Cellomar's Graphics

613 Swallow Drive Casselberry, Florida
cellomar@cfl.rr.com

When requesting permission to use one or more of my images, please complete this form and click the submit button.

Name		Company Name
Address		City
Address 2		City
State		Zip or Country code
Country		Zip or Country code
Phone		Fax
E-mail Address
Name of illustration(s)		Total number of illustrations
The above material will be used in the following publication:
Title		Author/Editor
To be published by		Publication date
Format	Paperback	Number of pages
	Hardcover
	Electronic
	Other
First print run		Price
Area	North America
	South America
	Worldwide
Other notes
	If you are editing the illustrations in any way, you must submit your rendering for our approval. Please allow up to 30 days for processing. Every effort will be made to process your request much sooner.