Copyright Infringement Form Contact Information Your contact info may be shared with the person who posted the content that you're reporting. You may prefer to provide your business or professional contact info. First name * Last name * Name of Copyright Owner * Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Number * Country (###) ### #### Username of Alleged Infringer Date of Alleged Infringement Copyright Ownership A report alleging infringement or violation of legal rights must come from the copyright owner or someone authorized to report on their behalf. If you aren't the copyright owner or an authorized representative, we won't be able to process your report. Your relationship to the copyright owner: * I am the copyright owner I am the legal counsel to the copyright owner I am a host, office, or director (non-legal) of the copyright owner I am an employee of the copyright owner I am an authorized agent of the copyright owner About your copyrighted work * Type of copyrighted work Video Original Music Non-Music Audio Photo/Picture Logo Other Description of copyrighted work * Include a clear and complete description of your copyrighted work that you believe was infringed. Statement * Check the applicable statements below. All statements must be true for you to submit your report. I have a good faith belief that the reported use of the material, in the manner complained of, is not authorized by the copyright owner, its agent, or the law. I state under penalty of perjury that the above information is accurate, and that I am the copyright owner or am authorized to act on behalf of the copyright owner. I acknowledge that all information submitted in my copyright infringement notification may be forwarded to the uploader of the content, to lumendatabase.org, or otherwise made public in any way by display or a third party. Signature * Include the signature of the copyright owner or an authorized representative of the copyright owner. You can type your full legal name as your electronic signature. display is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. I agree to receive occasional communications from display. You can unsubscribe from these communications at any time. I agree to receive occasional communications from display. By clicking submit below, you consent to allow display to store and process the personal information submitted above to provide you the content requested. Thank you!
