Dear (copyright holder name):
I would like to request permission to reprint the following content in my book titled (book title), which will be published by Publish Her, an independent publisher, and distributed via Ingram and Amazon.
Rights requested: world rights for the English languages, for all editions (including electronic/digital editions), use in promotional materials (such as book catalogs), in subsidiary licenses (such as translations or book clubs), and in versions made by nonprofit organizations for blind or physically handicapped persons.
Standard acknowledgment of title, author and publisher will be given, or I will gladly use the credit line that you supply. Please let me know what other information you might need from me and send the appropriate credit information.
If you do not hold copyright in this material, please let me know to whom I should apply.