Potential Infringement Form
Use this form to submit your matter for review by Leslie Burns
Name
*
First Name
Last Name
Email
*
example@example.com
Your Creation Date of the work at issue (best guess is ok)
*
-
Month
-
Day
Year
Date
If your work is PUBLISHED, the date of its FIRST publication; this may be when you provided it to your original client, or when you first offered it for licensing (if unpublished, leave blank)
-
Month
-
Day
Year
Date
Is the work registered with the US Copyright Office?
*
Yes
No
What is the Certificate number?
What is the Certificate's Effective Date?
-
Month
-
Day
Year
Date
List where the work is available legitimately, like the exact URL on your website
*
BE SPECIFIC! I need to see the work in its context.
When did you DISCOVER the infringement? (best guess is ok)
*
-
Month
-
Day
Year
Date
List the infringing URL(s), separated by a semi-colon (;)
*
Have you ever licensed a work for the same kind of use as the infringing use here?
*
No
Yes
How much did you charge for it?(USD)
(Do NOT give a hypothetical or aspirational number)
If you have more than one work infringed by this same infringer, please provide the same basic info asked above (registration status, number, etc.) here for each work.
Any other important info? For example, if you already contacted the infringer or the work was licensed to it but that license expired, let me know.
Submission Agreement
Clicking "Submit" below does NOT guarantee that Leslie will represent you in this matter; she is not your lawyer for this matter until you have both (1) an executed client services agreement; and (2) she agrees to represent you in this matter in writing (email).
Submit
Should be Empty: