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Copyright Counter Notice Form

Merchant's First and Last Name

Your First and Last Name

Your Email

Your Relationship to Merchant

Merchant's Street Address

City

State/ Province/ Region

Postal/ Zip Code

Merchant's Phone Number

Email

Description of the material that was removed or to which access was disabled

Description of the location where the allegedly infringing work was located on the Site before it was removed or access was disabled.

Untitled checkboxes field
Untitled checkboxes field
Untitled checkboxes field
Untitled checkboxes field

Typing your full name in the box acts as your electronic signature the same as if you physically signed. Note that your signature must match the name provided above in the “Your Full Name” box.

Date