Image/Text Theft Notice of Claimed Infringement

User ID: ________________________________________________________________________________

Full Name: _________________________________________________________________________________

Address: _____________________________________________________________________________________

City, State, Zip & Country: ______________________________________________________________________

Email Address (to be provided to reported sellers): __________________________________________________

Telephone: ____________________________________________________________________________________

Your original item number(s): _______________________________________________________

Type of content taken by reported seller(s) (image, text, or both): ___________________________

Item number(s) using your content: ____________________________________________________

Your original item number(s): _______________________________________________________

Type of content taken by reported seller(s) (image, text, or both): ___________________________

Item number(s) using your content: ____________________________________________________

Your original item number(s): _______________________________________________________

Type of content taken by reported seller(s) (image, text, or both): ___________________________

Item number(s) using your content: ____________________________________________________

Your original item number(s): _______________________________________________________

Type of content taken by reported seller(s) (image, text, or both): ___________________________

Item number(s) using your content: ____________________________________________________

I have a good faith belief that use of the material in the manner complained of above is not authorized by the Intellectual
Property Owner, its agent, or the law. The information in this Notice of Claimed Infringement is accurate, and under
penalty of perjury, I am authorized to act on behalf of the Intellectual Property Owner of an exclusive right that is
allegedly infringed.

__________________________________________ _____________________________
Signature Date

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