DMCA Takedown Notice Form

Copyright Owner Information

Full Name: Company Name (if applicable): Address: Email Address: Phone Number:

Identification of Copyrighted Work

Title of Original Work: Description of Copyrighted Material: URL of Original Work (if applicable):

Identification of Infringing Material

URL(s) of Infringing Material: Description of Infringing Material:

Statements of Good Faith

I have a good faith belief that the use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law. The information in this notification is accurate, and under penalty of perjury, I am authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.

Additional Information

Any additional relevant information:

Electronic Signature

By checking this box, I certify that the information provided in this form is accurate and that I am the copyright owner or am authorized to act on behalf of the copyright owner. Full Name: Date:

Disclaimer: Please note that under Section 512(f) of the DMCA, any person who knowingly materially misrepresents that material is infringing may be subject to liability.