So, you did a work of art for me a while ago, and I was hoping to use it in my book. Before doing that, I need to get permission from you (or confirmation of denial, if you choose not to allow me to use your art in my book).
In addition, I would like some contact information from you:
Your e-mail address
Your phone number
Your mailing address
Please only give what information you are comfortable giving.
Lastly, I would love a title for the work you gave me!
Please respond (or direct any questions) to email@example.com