Fillable Form

Limited Power of Attorney

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⚠️ Legal Disclaimer: This is a template for informational purposes only. Consult a licensed attorney or customs broker before executing any legal document.

1. Parties

Principal Name (your full legal name)

Agent / Attorney-in-Fact Name

Agent Company / Organization

2. Powers Granted

Add up to 7 specific powers.

3. Effective Date & Governing Law

Effective Date

Governing State

4. Signatures

Principal Printed Name

Principal Signature Date

Agent Printed Name

Agent Signature Date

5. Witnesses

Witness 1

Printed Name

Address

Witness 2

Printed Name

Address

6. Notary Acknowledgment

Notary State

Notary County

Notarization Date

Commission Expiry Date

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