Notice of infringement form

YOUR ADDRESS

Date: ______________

Dear Sir:

I, the undersigned, CERTIFY UNDER PENALTY OF PERJURY that I am the owner or an agent authorized to act on behalf of the owner of certain intellectual property rights. The name of such owner is ___________________________________ (the “Owner”).

I have a good faith belief that the material identified below is not authorized by the above Owner, its agent, or the law and thus infringes the Owner’s rights. Please act promptly to remove or disable the access to the material or items claimed to be infringing.

Location of the alleged infringing material.

____________________________________________

Description of the infringing material:

____________________________________________

Description of the copyrighted work that you claimed is infringed:

____________________________________________

You may contact me at:

Name: ___________________________________

Title: ___________________________________

Company: ________________________________

Street address: ____________________________

City, State: _______________________________

Zip: ___________________________________

Tel.: ___________________________________

Email: ___________________________________

Fax: _____________________________________

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