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Durable Power of Attorney

Information Submission Form
Name*

First Name Middle Name Last Name
E-mail
Address*

Street Address

Street Address Line 2

City State

Zip Code
What County Do You Live In?*
Phone Number
Additional Information

P.O.A. Information

Please Read Instructions Before Proceeding
A Durable Power of Attorney is a legal document wherein you give wide authority to another person (or persons) to make certain decisions on your behalf.

The autority you grant includes, but is not limited to, medical decisions, financial decisions, the ability to sign contracts on your behalf, etc.

On this page you will need to include:
1. The name of your Attorney in Fact (preferrable someone you know and trust)
Attorney in Fact*

First Name Middle Name Last Name
Co-Attorney in Fact
Include as many names as you'd like.
Additional information

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Delivery Method

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Payment Submission

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My Products*
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Durable Power of Attorney$25.00

Add Protective Blue Cover$10.00

Add Living Will$15.00

Total $0.00
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