Intellectual Property Claim

Campaign URL

Your Contact Information

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

State (Optional)

Country

E-mail Address

Confirm E-mail Address

Phone Number

IP Claim Details

Are you the Rights Owner or an Agent?

Rights Owner

Agent

IP Owner (Legal Name)

The specific concern is

URL(s) to original work

Additional Information (Optional)

Upload Image (Optional)

Statements

"I have a good faith belief that content(s) in the campaign described above violate(s) my rights described above or those held by the rights owner, and that the use of such content(s) is contrary to law."

"I declare, under penalty of perjury, that the information completed above is correct and accurate and that I am the owner or agent of the owner of the rights described above."

I have read and accept the statements above.