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* Indicates required field.
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Contact Information
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Title:
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[Mr., Mrs., Ms., etc.]
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Name:*
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[John Q. Public]
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Company:
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Address:*
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[1234 Elm St., Suite 007, Anytown, NY 98765]
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Phone:*
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[212-555-1212]
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E-mail:*
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[yourname@yourcompany.com]
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Information About the Intellectual Property
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Exact Web address on this site of the page in question:*
[www.DailyAdvance.com/pagename.html]
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Please provide the exact URL (or other specific location) of the intellectual property in question, and describe, in as much detail as possible, why you believe it has been improperly posted or distributed by this site.*
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Your relationship to the owner of the intellectual property:*
[owner, authorized representative, etc.]
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You represent, under penalty of perjury, that the information you provided above is accurate and completed, and that you are the copyright owner or are authorized to act on behalf of such person or entity. You also represent that you maintain a good faith belief that the use of the materials you referenced above are not authorized for use on this site by the copyright owner, its agent, or by operation of law.
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