Your Contact Details - This is the contact Eclectic will use

 

Secondary Contact Details

The contact details which we should provide to Third Parties (if relevant) for enquiries regarding this notification.

Statements

I have a good faith belief that I have a dispute or claim of legal rights violation. I represent, under penalty of perjury, that the information in this notification is true and correct and that I am the rights owner or authorised to act on behalf of the rights owner for the rights described above.