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Net Attorneys
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]
_________________________________________
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.
