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Copyright Registration Order

Please complete the series of questions to the best of your knowledge, if you are unsure of any of the questions, please leave it blank.

1. What year was the copyrighted work completed

	Year:

2. State the name(s), citizenship(s), and dates of birth for the creator(s) of the work

	Author #1:
	Name:
	Citizenship:
	Date of Birth:

	Author #2:
	Name:
	Citizenship:
	Date of Birth:

If the material has been published or publicly distributed, please give the date of the first publication or earliest distribution and the nation of the first publication or earliest distribution

	Date of first publication or earliest distribution:
	Nation of first publication or earliest distribution:

3. Please Select Service Requested:

Price

Copyright Registration Application (includes the $45 government fee)

$245

4. Customer Information

Your Name

Company Name

Email Address

Telephone No.

Address

City/Town

State/County

Zip Code

Country

Special Instructions:

5. Payment Information:
Card Type:
Card Number:
ExpirationDate:
Verification Code		last 3 digits on the back of your card)
Name on Card:

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Since 1999

For over 15 years, Patel & Almeida has been the trusted leader in protecting the intellectual property of our clients.

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