Copyright 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 Leslie must have a signed agreement before she represents you in this or any matter.

First Name

Last Name

Email

Your email address

List the URL(s) for the infringement

If you know the URL where the work is stored on the infringer’s server, please include that too

Is/Are the copyrights registered with the USCO? No Yes

Don’t say “yes” unless you have received your certificate

If registered, what’s the Certificate Number

should be something like VA2-222-222

What is the Effective Date for the Certificate

When did you first publish the work, or offer it for license to others?

URLs where you or your licensees publish the work

please be specific so I can see the work in context

Do you always have your CMI on/adjacent to the work? Yes No

CMI is a watermark or credit line

Is your CMI missing in the infringement? Yes No

License Fee?

What you would have charged any client for a license for the same usage

Any other info you want to share about this?