Request To License iSixSigma Copyrighted Materials

This form is only valid for articles found on www.isixsigma.com. For articles found in iSixSigma Magazine (the print magazine of iSixSigma),
please visit www.isixsigma-magazine.com/reprint.

 Please provide the following information:
 URL of Article:    ____________________________________________________________
 Title of Article:    ____________________________________________________________

 Medium (Check all that apply):
 
 _______ Print (one edition, $100 per item)

 _______ Print (all editions, $250 per item)

 _______ Intranet (30-day use limit, $100 per item) - For longer-term use or
         special circumstances, please contact iSixSigma copyright requests.
 For longer term use or special circumstances, contact us.
 Intended Use (Be specific):    ____________________________________________________________
     ____________________________________________________________
     ____________________________________________________________
 Person Making Request:    ____________________________________________________________
 Email Address:    ____________________________________________________________
 Phone Number:    ____________________________________________________________
 Company/Institution:    ____________________________________________________________
 Address:    ____________________________________________________________
 City/State/Zip:    ____________________________________________________________
 Total:    $__________
     
 Please make checks, drawn on U.S. Banks only, payable to iSixSigma.
     
 To pay by credit card, please provide the following information:
 Visa, Mastercard and American Express accepted.
 Name On Card:    ____________________________________________________________
 Card Number:    ____________________________________________________________
 Expiration Date:    ____________________________________________________________
 Type Of Card:    ____________________________________________________________
     
 Mail this form to:
 iSixSigma Copyright Requests
 321 High School Road NE, PMB 434
 Bainbridge Island, WA 98110
 Or fax this form to: +1-206-774-6423