Request for Permission to Arrange. Standard Form Recommended by: Music Publishers' Association of the United States, and National Music Publishers' Association, Inc.

Request for Permission to Arrange
Instructions: After completing Part I of this form, clicking “send” will forward it to the publisher who will complete Part II of the form and return it to you by e-mail. This return copy will either give permission, deny permission, or ask for payment. If the publisher indicates a payment for the right you request, and if the conditions are agreeable to you, remit the amount to the publisher together with a copy of the agreement, whereupon the agreement will be completed and a copy of the permission will be sent to you.

Part I

To:
[date]

Gentlemen:
We hereby request your permission and non-exclusive license to arrange the following musical composition:

(herinafter referred to as "The Arrangement")

The Arrangement will be for band, orchestra, chorus, chamber/mixed ensemble, piano/vocal, other in 1-5, 6-10, 11-50 instrumental and/or vocal parts
We will produce 1-5, 6-10, 11-50, 50-100, 100-200, one full ensemble set of parts
copies of The Arrangement for use and performance only by our teachers, students, members, congregation.
No right to record or to reproduce additional copies is granted to us. We understand that if we wish to record The Arrangement a separate license will be required. We agree not to distribute (except for use of copies as provided in Paragraph 1), sell, load, or lease copies of The Arrangement to anyone.

[name of institution]
[address]
[e-mail address]
By: