Trademark Infringement Ad Takedown Notice

Date:

Recipient Information

Recipient Name / Company: Recipient Address:

Your Information

Your Name / Company: Address: Email: Phone:

Trademark Information

Trademark Name: Trademark Registration Number (if applicable): Jurisdiction:

Allegedly Infringing Advertisement(s)

Ad Platform (e.g., Google, Facebook, etc.): Ad Link(s): Description of Infringement:

Statement of Good Faith

Declaration

I declare, under penalty of perjury, that the above information is true and accurate and that I am authorized to act on behalf of the trademark owner.