| Infringing Company: (*) | |
| Contact Name: | |
| Address Line 1: | |
| Address Line 2: | |
| City: | |
| State: | |
| Zip: | |
| Phone Number: | |
| Reported By: | |
| Reported By Phone: | |
| Reported By Email: | |
| Location of Goods: | |
| Marks Involved: (*) | |
| (Name and Mark for schools / properties) | |
| Products: (*) | |
| Manufacturer of Product: | |
| (If different from Infringing Company) | |
| Additional Info: | |
| You may be contacted by CLC via E-mail for more information if necessary. Your name and E-mail will be kept in complete confidence. | |
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