Copyright Infringement Evaluation Form

Please fill out this form as much as possible so that Leslie can review your matter to see if she can help and whether she can do so on a contingency fee. She will get back to you as soon as possible, but it may be a couple of business days, depending on her schedule. NOTE: Filling out the form does NOT make you a client–you and Burns the Attorney, Inc. must have a signed agreement before Leslie represents you in this, or any, matter.

PLEASE NOTE: The form will capture your IP address–sadly, we get threats and an IP address can be used to identify the sender. 

First Name

Last Name

Email

Make sure this is acurate, especially if you are a previous client.

Work’s Creation Date

When you (or orig. author) created the work at issue

First Publication Date

Date you first offered the work for licensing or provided it to a client

Is the © registered? No Yes

Only say "yes" if you have received a certificate

© Certificate Number

Certificate Date

The Effective Date found on your certificate

ALL the URLs where you or your licensee(s) show the work

Please be specific to the location of the work, not just www.mywebsite.com bur rather mywebsite.com/images/image123.html; I need to see the work in its context wherever you know it appears legitimately.

Have you confirmed your legitimate users/licensees have NOT shared the work with the alleged infringer? I have NOT confirmed I have confirmed

This is an important step. If you have not yet done this, I will ask you to do so before I agree to take the matter.

Do you ALWAYS display the work with a watermark or credit line? Yes No

Credit lines and watermarks are forms of Copyright Management Information (CMI)

Is the CMI (watermark, credit line) missing in the infringing use? Yes No

URL(s) of infringing use(s)

Be as specific as possible; also please make screenshots of these locations; if you know the server address where the work resides, include that/those as well

Usual License Fee

What is your customary license fee for a legitimate similar use?

Do you have invoices or other proof of the license rate? please select no yes

Any other info you want to share

Submission ≠ obligation to represent you

By clicking, you agree that this submission is for review only; that is, Leslie/Burns the Attorney, Inc., does not represent you in this matter and will not until you both agree, in writing, that she/it does.