InternetLitigators

Client Contact Information

How you would like us to contact you.

Name*

First Last

Billing Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Online Service Provider Information

This is the primary name of your business used as an Online Service Provider. You may identify additional names that this entity operates under for listing in addition to the primary name if you like as well.

Document Preparation Fee (Includes One Basic Filing Fee)*

Price: $ 19.00

Full Legal Name of Service Provider*

Typically Your Company Name.

Optional Additional Names

If you operate under names other than the name listed above you may include additional names here.

Additional Domains*

Price: $ 2.50 Quantity:

List Your Additional Names Here (One Per Line)*

Agent Information

If you designate InternetLitigators as your agent we will monitor your DMCA notices and advise you of the need to comply. Our name and address will be available to the public on your behalf and should be identified in your terms of service or DMCA Policy. If you chose yourself or another person you will be solely responsible for compliance. See our Terms of Service for more details.

Choose Your Agent*

I designate InternetLitigators my DMCA Agent
I wish to designate my own DMCA Agent

First Month Fee (recurring monthly fee - cancel any time)*

Price: $ 35.00

You may not list InternetLitigators as your agent with the copyright office or on your website without an active DMCA Agent subscription. Doing so will result in your non-receipt of any notice we may receive and potential liability for failure to comply with the DMCA.

Name of Agent Designated to Receive Notification of Claimed Infringement:*

Full Address of Designated Agent to which Notification Should be Sent*

Street Address Address Line 2 City State ZIP Code

(a P.O. Box or similar designation is not acceptable except where it is the only address that can be used in the geographic location)

Telephone Number of Designated Agent:*

Facsimile Number of Designated Agent:*

Email Address of Designated Agent*

Total

$ 0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Authorization

Appointment and Authority*

I hereby appoint InternetLitigators as my representative for the purpose of designating my Agent to Receive Notification of Claimed Infringement. If this form is submitted on behalf of an entity, I hereby further certify that I am fully authorized to make this appointment without any further action on the part of the entity. I have read and agree to the Internetlitigators Terms of Service and Privacy Policy.

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