Interim Designation of Agent To Receive Notice

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Amended Interim Designation of Agent To Receive Notice Of Claimed Infringement

Amended Interim Designation of Agent To Receive Notice Of Claimed Infringement

Full Legal Name of Internet Service Provider is: [Insert Full Legal Name Here]

Alternative Names of Service Provider (including all names under which the service provider is doing business): [Insert all fictitious names, assumed names, and other names under which you are doing business here]

Address of Service Provider:  [Insert business address of Service Provider here]

Name of Agent Designated to Receive

Notification of Claimed Infringement:  [Insert Name of Designated Agent Here]

Full Address of Designated Agent To Which Notification Should Be Sent (note that a Post Office Box or similar designation is not acceptable except where it is the only address that can be used in the geographic locations):  [Insert Full Address of Designated Agent Here]

Telephone Number of Designated Agent: [Insert Telephone Number of Designated Agent Here]

Facsimile Number of Designated Agent: [Insert Fax Number of Designated Agent Here]

Email Address of Designated Agent: [Insert Email Address of Designated Agent Here]

Identify the Interim Designations to be Amended, by Service Provider Name and Filing Date, so that it may be Readily Located in the Directory Maintained By The Copyright Office: [Place Information Here]

_________________________________________

Signature of Officer or Representative of the

Designating Service Provider

Date: _____________________________

_________________________________________

Typed or printed name and title:

NOTE: This Amended Interim Designation Must Be Accompanied by a $20.00 Filing Fee Made Payable To the Register of Copyrights.

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