My copyrighted work: [state your URL item here]
The infinging item: [state the URL of the item that used your work]
This is a copyright for the following reasons:
1. [state your reason on why/how you think he steals your work]
2. [state your reason on why/how you think he steals your work]
3. [state your reason on why/how you think he steals your work]
Name: [your name]
Address: [your full address]
Tel: [your telephone number]
Email: [your email address]
I have a good faith belief that use of the copyrighted materials described above as allegelly infringing is not authorized by the copyright owner, its agent, or the law.
I swear, under penalty or perjury, that the information in the notification is accurate and that I am the copyright owner or am authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.
[your signature here]
Once you have write the above, print it out, and then put your signature on it. After that, scan it into an image file (JPEG) and send it to agency by email.
I hope the above will help those in need of a DMCA sample.