Free Agent Power of Attorney Form Template

Agent Power of Attorney Form

Please complete this form to designate an agent to act on your behalf.

Principal Information

Name

    Address

      Phone Number

        Agent Information

        Name

          Address

            Phone Number

              Authority Granted

              Specify the authority granted to the agent:

                Effective Date

                  Duration

                    Special Instructions

                      Signatures

                      I hereby grant the Agent named above the authority specified in this form. I understand the responsibilities and consequences of granting this Power of Attorney and do so voluntarily.

                      Principal

                      Name:

                      Date:

                      Agent

                      Name:

                      Date:

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