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This mailbox is reserved for reprint and distribution requests.

This form is for use by all third parties seeking permission from Accu-Glass to:

check relevant box(es)

 Reprint, republish or otherwise copy or distribute materials, e.g. printed documents, digital images, videos, CD-Roms or other media, which are owned or controlled by Accu-Glass; and/or

 Use Accu-Glass's name in a press release or any other public document, including marketing and promotional materials. SUBMISSION OF A REQUEST IS THE FIRST STEP IN THE APPROVAL PROCESS; IT DOES NOT CONSTITUTE APPROVAL. ACCU-GLASS WILL NOTIFY YOU WHEN YOUR REQUEST HAS BEEN APPROVED.


* Required Field

* First Name:   

* Last Name:   
* Organization (Licensee):   
* Name of Individual Authorized to Sign   
Permission Form (Signatory):   
* Relationship of Signatory to Licensee:   
* Address 1:   
Address 2:   
* City:   
* Postal/Zip Code:   
* Country:   
* State (US only):   
* Telephone:   
* Fax Number:   
* Signatory E-mail Address:   
* Relationship with Accu-Glass:   
 
 
* Describe in detail the material(s) for which you request permission to reprint: (e.g., include a) the full title, author and copyright date of published article, as well as the document number, if known; or b) distinguishing characteristics of digital images and source description; or c) specific URLs for web page content; or d) full draft of the press release or other marketing material, etc.)

1000 character limit. Please e-mail the full-text of documents larger than 1000 characters to: info@accu-glass.com and reference "Permission Request."

Catalog Number (if known):


* Describe in detail for what purpose the material(s) will be used:

250 character limit. Please e-mail the full-text of documents larger than 250 characters to: info@accu-glass.com and reference "Permission Request."

* For what duration will the
material(s) be used?


* Do you have samples of the material(s) requested?
           Yes      No

* Name of your Accu-Glass contact:


* Date permission required:


Before submitting personal information to us, we encourage you to read our Privacy Statement and Consent to Use of Data. This Statement contains important information about how we will handle and use your personal information. After you have had a chance to review the Statement, please acknowledge your acceptance of terms by selecting the box below. If you choose not to accept, the information you just completed will not be submitted to Accu-Glass.
* I accept the terms of the Privacy Statement.