DMCA Designated Agent Service Intake Form

If an individual is the service provider (sole-proprietor), please provide the full legal name, OR provide the full legal name of any business entity that is the service provider instead (in the First Name box) as it appears on the organizing documents (i.e. "Acme, LLC"). What you list here will appear on the DMCA records as the name of the service provider. This means the full legal name of an individual sole-proprietor, corporation or LLC name if applicable. We WILL NOT do any independent review of applicable secretary of state databases to determine the actual service provider correct legal entity name-this is your responsibility to confirm before submitting this form. Note, the US Copyright Office will require us to provide the actual full address for your company and not a P.O. Box unless you receive permission to do so. (This address is visible on the DMCA database, but not the service provider phone or email contact info.)

Provide the principal business address of the website/app operator. Service providers are required to supply the full physical street address and not a P.O. Box (or virtual address). However, you may petition the Copyright Office for permission to use a P.O. Box (or virtual address). You will be required to take this step separately after registration. Please note, any address information will be reflected on the DMCA database in connection with the service provider.