COPYRIGHT INTAKE FORM
Please fill out this form to help us gather important information about your case.
Each answer on this form must be completed in full
.
If this form is only partially completed, we will not be able to proceed and you will need to submit the entire form again.
Do not submit answers to this form via email, social media, text messages, etc.
The answers you submit in this form are confidential.
This form DOES NOT create an attorney-client relationship. No attorney-client relationship exists until you sign a contract with our firm AND pay your invoice.
Point of Contact Information
Who will we be communicating with regarding the copyright service?
Contact information
Prefix
First name
*
Middle name
Last name
*
Emails
Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Addresses
Street address
Country
Australia
Canada
United Kingdom
United States
---------------
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
City
State/Region
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Virginia
Virgin Islands, U.S.
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Province/Region
Zip/Postal code
Address type
Work
Billing
Home
Other
Primary
Default address false
Add address
Phone numbers
Phone number
Type
Work
Home
Mobile
Fax
Pager
Skype
Other
Primary
Add phone number
Copyright Information
What do you want to copyright?
Photo
How many?
Were these all taken at once (if multiple)
Video
Fashion Design
Poem
Book
Song
PowerPoint Presentation
Graphic design
Architecture/Sculpture
Website
Online Course
Software
Other
Please describe.
Upload a copy or photo of your work. THIS IS MANDATORY.
Add attachment
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What is your current website URL?
What are your social media handles?
Ownership Information
Who owns the work? Use "Individual" if you have not yet registered your LLC/business.
What type of entity is the owner?
Individual
What is the full legal name of the Individual Owner?
Which state is the Individual Owner a resident of?
Is the Individual Owner a U.S. citizen?
LLC
What is the full legal name of the LLC?
Which state is the LLC organized in?
Is the LLC currently (today) in good standing? Type YOUR FULL NAME to confirm you have checked the Secretary of State's website to confirm that the LLC is in good standing.
Does the LLC use any alternate name, alias, or trade name?
What is the full name of the Member/Authorized Representative that has authorization to sign on behalf of the LLC? If same as Point of Contact, write "Same as POC".
Partnership
What is the full legal name of the Partnership?
What state is the Partnership formed in?
Does the Partnership use any alternate name, alias, or trade name?
List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals.
Are all related parties citizens of the United States?
Limited Partnership
What is the full legal name of the Limited Partnership?
Which state is the Limited Partnership formed in?
Does the Limited Partnership use any alternate name, alias, or trade name?
List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals.
Are all related parties citizens of the United States?
Corporation
What is the full legal name of the Corporation?
What state is the Corporation incorporated in?
Does the Corporation use any alternate name, alias, or trade name?
Is the Corporation currently (today) in good standing? Type YOUR FULL NAME to confirm you have checked the Secretary of State's website to confirm that the Corporation is in good standing.
What is the full name of the Member/Authorized Representative that has authorization to sign on behalf of the Corproation? If same as Point of Contact, write "Same as POC".
Joint Venture
What is the full legal name of the Joint Venture?
What state is the Joint Venture formed in?
Does the Joint Venture use any alternate name, alias, or trade name?
List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals.
Are all related parties citizens of the United States?
Sole Proprietorship
What is the full legal name of the Proprietor?
Which state is the Sole Proprietorship formed/operating in?
Which state is the Proprietor a resident of?
Is the Proprietor a U.S. citizen?
Does the Sole Proprietorship use any alternate name, alias, or trade name?
Trust
What is the full legal name of the Trust?
Which state was the Trust formed in?
What is the full name of the Trustee that has authorization to sign on behalf of the Trust?
Does the Trust use any alternate name, alias, or trade name?
Estate
What is the full legal name of the Estate?
Which state is the Estate formed/operating in?
What is the full name of the Executor that has authorization to sign on behalf of the Estate?
Does the Estate use any alternate name, alias, or trade name?
Owner Address
What is the full address of the owner? If it is the same as the Point of Contact, write "SAME".
Include Street, Unit/Suite No., City, State, and Zip.
Is the address a physical address?
Yes, this is a physical address
No, this is a virutal address (but not a PO Box or UPS Store)
No, this is a UPS Store
No, this is a PO Box
Owner Business Name
Do you have a trademark for your business name?
Trademarks protect names, logos, and slogans.
Yes
Is the trademark registered or pending?
What is the application number or registration number?
Upload a copy of the registration.
Add attachment
Add attachment
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No
Truthfulness Confirmation
I confirm that the information I provided in this form is complete, correct, and true to my knowledge and belief.
Yes
Type YOUR FULL NAME to confirm that you understand that we rely on your honest answers.
I confirm that I have authorization (if owner is you, your company, employer, another party, etc.) to complete and submit this form.
Yes
Type YOUR FULL NAME to confirm that you have authorization to submit this form.
How did you hear about Ana Law?
Podcast
Which podcast?
LinkedIn
TikTok
Instagram
Facebook
YouTube
Twitter
Attorney Referral
Who is the attorney (or firm) who referred you?
Client Referral
Who is the person (or company) who referred you?
Google Search
State Bar Website
Super Lawyers Website
THANK YOU
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