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To request permission to use material from a Wiley-VCH title you may submit your request in writing, via fax at +49 (0)6201/ 606-332, conventional mail (Wiley-VCH Verlag GmbH & Co. KGaA, Rights & Licenses, Boschstr. 12, 69469 Weinheim ), or online by completing the appropriate form below.

First Name: *
Last Name: *
Name of Company or Organization:
Street Adress: *
City: *
State/Province:
Zip/Postal Code: *
Country: *
Contact Phone Number:
Fax:
E-mail Adress: *
Your Reference Number (if any):
Wiley product/title from which you'd like to reprint (For journals, please provide the journal name and not the individual article title):

Is this title a book or a journal?	Book 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 numbers, figures/tables, and/or total word count you wish to reproduce:
Maximum print run estimate:
Your Publisher:
Title of Your Work:
Projected Publication Date:
Format of Your Work (Check all that apply):
Print
CD-ROM
E-Book:
Reader Type (Adobe Acrobat or Microsoft):

WWW:
What is the url where the material would be located?:

Is the web site where the material will be posted password protected, or is access to the site limited in any way?	Yes No

How many users would have access?

How long will the material be posted (not to exceed a two year limit)?	From: (dd/mm/yyyy)
	To: (dd/mm/yyyy)

Intranet:
What is the url where the material would be located?:

Is the web site where the material will be posted password protected, or is access to the site limited in any way?	Yes No

How many users would have access?

How long will the material be posted (not to exceed a two year limit)?	From: (dd/mm/yyyy)
	To: (dd/mm/yyyy)

Software Program: (i.e. Powerpoint, database, disk):

Other (Please Specify):

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

* = Required fields

John Wiley & Sons, Inc.
and Wiley-Liss, Inc.
Permissions Department
111 River Street
Hoboken, NJ 07030-5774
USA
PermissionsUS@wiley.com

Wiley-Blackwell Inc.
John Wiley & Sons, Ltd.
Permissions Department
The Atrium
Southern Gate
Chichester
West Sussex PO 19 8SQ
United Kingdom
PermissionsUK@wiley.com

Wiley-VCH Publishers
Rights and Permissions
P.O. Box 10 11 61
D-69451 Weinheim
rightsDE@wiley.com


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