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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?

Right Owner

Agent

IP Owner (Legal Name) *

The specific concern is *

URL(s) to original work *

Additional Information (Optional)

File Attachment (limit 5 file)

No file chosen

Please upload any proof of intellectual property ownership.

Example: A design source file (Adobe Photoshop/Illustrator), or a trademark/copyright ownership certificate with relevant identification documents.

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.

Campaign URL *

It contains hate speech or is used for harassment

It contains graphic sexual or pornographic

It promotes or advocates violence or harm

It makes false, confusing, or misleading claims

It promotes or advocates illegal

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