To whom it may concern:
I found your page <page name or URL> while doing research for the free online encyclopedia Wikipedia, and thought your image [regarding <topic>] might be appropriate for inclusion in our articles concerning <subject>.
I am specifically seeking your permission to use this image: <URLs>
I would like to include your image in these articles: <Article URLs>
Wikipedia (http://www.wikipedia.org/) is a free encyclopedia that is collaboratively edited by volunteers from around the world. Our goal is to create a comprehensive knowledge base that may be freely distributed and available at no charge.
Normally we ask permission for material to be used under the terms of the GNU Free Documentation License. This means that although you retain the copyright and authorship of your own work, you are granting permission for all others (not just Wikipedia) to use, copy, and share your materials freely so long as they do not try to claim the copyright themselves, nor prevent others from using or copying them freely.
You can read this license in full at: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GFDL
This license expressly protects creators from being considered responsible for modifications made by others, while ensuring that creators are credited for their work. There is more information on our copyright policy at: http://en.wikipedia.org/wiki/Wikipedia:Copyrights
We choose the GFDL because we consider it the best available tool for ensuring our encyclopedia can remain free for all to use, while providing credit to everyone who donates text and images. This may or may not be compatible with your goals in creating the materials available on your website. Please be assured that if permission is not granted, your materials will not be used at Wikipedia -- we have a very strict policy against copyright violations.
We also accept licensing of images under other free-content licenses like some Creative Commons licenses - see http://creativecommons.org for this.
With your permission, we will credit you for your work in the image's permanent description page, noting that it is your work and is used with your permission, and we will provide a link back to your website. Please explicitly state under which license you grant permission.
We invite your collaboration in writing and editing articles on this subject and any others that might interest you. Please see the following article for more information. http://en.wikipedia.org/wiki/Wikipedia:Introduction
Thank you for your time.
Kindly, <your name>