Power of Attorney FormPower of AttorneyHiddenAgent NameHiddenAgent Email HiddenToken Business InformationType of Business Individual Partnership Corporation Sole ProprietorshipLEGAL BUSINESS NAME *(Required)Individual — State person’s full name.LEGAL BUSINESS NAME *(Required)LEGAL BUSINESS NAME *(Required)Partnership — Indicate full name of each partner and partnership name.LEGAL BUSINESS NAME *(Required) Sole Proprietorship — Indicate full name of individual and company.LEGAL BUSINESS NAME *(Required)Corporation — Indicate full legal company name.I.R.S / Social Security Number / EINPlease indicate your corporate I.R.S. # / SocialSecurity # (Whichever is applicable)I.R.S / Social Security Number / EIN(Required)Please indicate your corporate I.R.S. # / SocialSecurity # (Whichever is applicable)Doing Business As (DBA)If you operate as a DBA, Complete this only if you trade under a different name Company AddressOfficial physical address of the company’s home office, or individual home address.Address 1(Required)Address 2City(Required)State(Required)Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZipcode *(Required)Residing at Signer’s InformationFull name of individual signing the power of attorney. The individual must hold one of these titles: Owner, Partner, President, Vice-President, CEO, CFO, Secretary or Treasurer.HiddenSigner First nameHiddenSigner Last nameSigner's Full Name(Required)Signer's Capacity (Title)(Required)Signer's Capacity (Title)*PresidentVice PresidentCFO Chief Financial OfficerCEO Chief Executive OfficerCOO Chief Operation OfficerCAO Chief Administrative OfficerChairman (person) or Chairman (person) of the BoardTitle of the signer.Signer's Capacity (Title)(Required)PartnerTitle of the signer.Signer's Capacity (Title)(Required)OwnerTitle of the signer.Signer's Email *(Required) HiddenWitness's Full NameName and signature of witness (Not required unless specifically required by your State/Provincial/Federal government).POA Date(Required) DD slash MM slash YYYY Date power of attorney is being granted.POA Date(Required) DD slash MM slash YYYY Date power of attorney is being granted.Activation Date(Required) DD slash MM slash YYYY Activation Date is being granted.Termination Date(Required) DD slash MM slash YYYY Activation Date is being granted.Need assistance? We will be happy to help. Please contact us at info@unicargo.com
