New Helfta
Permissions License
Date: ______________________
License
agreement made between Licensor: Minhhang K. Huynh, artist /
iconographer / calligrapher
and
Licensee:__________________________________________Company:________________________________
Address:
______________________________________________________________________________________
Phone/Fax:
______________________________________ Email:________________________________________
for permission to use the image(s) of
________________________________________________________________
to
____________________________________________________________________________________________
______________________________________________________________________________________________
with the below specifications:
1.
The image is not to be altered or renamed. (To be complete by the licensee)
a. Date of intended publication: ________________
b. Design artist/printer/publisher:
_____________________________________________________
c. Title of the book/CD/Tape:
________________________________________________________
d. Number of copies requested permission: ____________
e. Production is for __
profit /__ non-profit.
If for profit, how much will an item be sold for?
Others: _____________________________________________________________________
2. The foregoing permission is hereby
approved and granted subject to, (To be complete by the licensor)
if the production is for non-profit,
___ a/ giving ____
copies of the books published to the Licensor.
___ b/ a nominal charge of $ _____
if the production is for profit,
___ a/ a nominal charge of $ _____
___ b/ a royalty fee of
$ _____ (20% of the sale profit. This includes images to be used as the cover
image (i.e. tapes, CD’s, books, etc.)
___ c/ a royalty
of $ _____ (40% of the sale profit. This includes the reproduction of the image
itself (i.e. cards and posters)
3. Printing the following form of credit
with the reproduced image (s):
Name of art work:
_____________________________________
ã YEAR,
Minhhang K. Huynh.
www.ourladyofnewhelfta.com . Used with permission.
4. This permission shall terminate if
a/ any of the above terms is violated.
b/ the intended production is not published by the Licensee
within 1 year of approval.
The foregoing outlines all terms of this permission. Licensee’s signature below
shall indicate Licensee’s
understanding and
approval of the terms set forth herein.
___________________________ Date: __________ ____________________________ Date: ___________
Signature of Licensee
Signature of Licensor
___________________________________________ Minhhang K. Huynh
Print name
Updated March 2006
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