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QComp.net | Trademark Violation Claim Form

Please fill in all fields marked with a *

Domain Name:  *

Trademark Term:  *

Trademark Registration Number:  *

The jurisdiction or geographical area to which the mark applies:  *

Your First Name:  *

Your Last Name:  *

Your Email Address:  *

Phone Number:  *

Street Address:  *

Street Address 2:  

City:  *

State/Province:  *

Zip Code:  *

Country:  *

The goods and or services covered by or offered under the mark identified above:*

The date of first use of the mark identified above:  *

The date of first use in interstate commerce of the mark identified above:  *

A description of the manner in which the Complaining Party believes its mark is being infringed upon:*

The precise location of the infringing mark, including electronic mail address, etc.*

A good faith certification, signed under penalty of perjury stating:*

  1. The content of the website [identify website] infringes the rights of another party,
  2. The name of such said party,
  3. The mark [identify mark] being infringed, and
  4. That use of the content of the website claimed to be infringing at issue is not defensible.

Electronic Signature:  *

Additional information you would like to include that would help the process: