LICENSING

Pauline Books and Media Licensing Request Form

Date of Submission: _______________________________________________

Information Pertaining to Our Book:

Title of Interest: ___________________________________________________

Author:  _________________________________________________________

Estimated publishing date: _________________________________________

Please four business days for processing your request.

Requester Information:

Name: __________________________________________________________

Position: ________________________________________________________

Company: _______________________________________________________

Address: ________________________________________________________

City:  ___________________________________________________________

State:  __________________________________________________________

Zip Code: ________________________________________________________

Phone:  _________________________________________________________

Fax:   ___________________________________________________________

E-mail: __________________________________________________________

If mailing your request, please allow 3-5 weeks for a response.  If emailing your request, you may expect a response to your inquiry within 3 business working days.

 A self-addressed stamped envelope would be appreciated.