Permission Request

First Name First Name is required. 0/

Last Name Last Name is required. 0/

Organization Organization is required. 0/

Identify the entity type, for example, “LLC,” “Non-profit,” “Ltd.” etc Entity type is required. 0/

Title Title is required. 0/

Name of Individual Authorized to Sign Permission Form (Signatory) Signatory is required. 0/

Title of Individual Authorized to Sign Permission Form Signatory Title is required. 0/

Address 1 Address is required. 0/

Address 2 0/

City City is required. 0/

ZIP Code ZIP code is required. Please enter valid ZIP code (e.g. 10001). 0/30

Phone Please enter phone number in the following format: 5555555555 Phone is required. Please enter valid Phone Number (e.g. 3334445555) 0/30

Fax Please enter fax number in the following format: 5555555555 Please enter valid Fax number (e.g. 5556667777) 0/30

Signatory E-mail Address Signatory Email Address is required. Please enter valid email address. 0/

Description of Material & Purpose of Use Describe the requested material in detail and the purpose of use Material and Purpose of Use is required. 0/

Description of Manner of Use Provide details on the manner/form, expected length, location and/or medium of use. Include details such as the full title, edition, publication issue, description of publication, website, video, or other media, as applicable. 0/

Name of Contact at GSUSA Name of the Contact is required. 0/

Date Permission Required Please enter Date in this format: MM/DD/YYYY Permission Date is required. Please enter valid Date of Permission Required. 0/