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Inquiry Form on Out-of-Print Music

(Photocopy form as needed.)
Prepared by: Music Publishers’ Association of the US, and National Music Publishers’ Association, Inc. Modified by Central Virginia  Community College for its use.


This form is to be prepared in duplicate. After completing the boxed section and signing both copies where indicated, forward them to the publisher who will complete the form and return it to you. 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 the original copy, signed by the publisher, whereupon the agreement will be completed.

CVCC faculty and staff must contact the Vice President of Financial and Administrative Services prior to completing this form.
To: ___________________________________________ (Name of Publisher)
Address: _______________________________________
From: ______________________________________
Vice President for Finance and Administration
Central Virginia Community College
            3506 Wards Road
Lynchburg, Virginia 24502
434- 832-7614 (phone) 434-386-4700 (fax)
The College wishes to procure ________ copies of your copyrighted publication:
_______________________________________________ (Title)
_______________________________________________ (Arrangement)
_______________________________________________ (Composer)
If it is in print:

Please indicate the price per copy here $ ___________
If it is out of print: 

A)    Do you have plans to reprint it? ________ If so, when? _________________________
At what price per copy? _________
Page 2
B)     If there are no plans for reprinting, we request your permission to have a nonexclusive right to reproduce by photocopy _______ copies for use by our ____________________.
                                                                                                        (students, faculty, etc.)
The copies will be identical to your publication, including the copyright notice. The following will be legibly included on the first page of each copy of our reproduction:

"This reproduction is made with the express consent of _______________________________
                      (copyright owner’s name)
in accordance with the provisions of the United States Copyright Law."

The College acknowledges that it is granted no right to sell, loan, or otherwise distribute reproduced copies of the publication other than for the use set down above. No other rights of any kind for any other use are included in this permission.
If permission to make copies can be granted:

Will you charge a fee? _______________
If so, how much? ______________
If you do not grant the above permission:

Will you supply me (us) with _________photocopies? ___________

If so, at what price per copy? _______________
By: ______________________________________________ Date: _______________
(Vice President for Finance and Administration)
Accepted and Agreed to By: _________________________________________________
Title: _____________________________________________ Date: _______________
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