Financial power of attorney (POA)

If you are married, each spouse should complete a separate form/entry.

Your Name*
First Middle Last
Please enter your name exactly as you would like it to appear in your power of attorney.
Do you wish to have your Financial Power of Attorney effective immediately? (typically recommended)
- Yes
- No
If you choose no, your financial power of attorney will only become effective if you are determined to be incapacitated or unable to make decisions regarding your finances. This can sometimes make it more difficult for your agent to access your finances in an emergency.
Designation of "Agent"
Your “Agent” is the person that will make financial decisions for you (such as accessing your bank account or signing legal documents) if you are not able to do so yourself, either because you are not able to be present, or because you are incapacitated.
Do you wish to have your spouse be your first Agent?
- Yes
- No
If you are not married, please select “no”.
Who do you want to appoint as your first Agent?
First Middle Last
Relationship to you
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Email address

Designation of Successor / Alternate Agents
I recommend choosing at least one successor agent, in case the first person you named as an agent is not able to serve.
Who do you want to name as the first alternate Agent?
First Middle Last
Relationship to you
First alternate Agent address
Street Address Address Line 2 City State ZIP Code
First alternate Agent phone
First alternate Agent email address
Do you wish to identify a second alternate Agent?
- Yes
- No
Provide the full name of your second alternate Agent
First Middle Last
Relationship to you
Second alternate Agent address
Street Address Address Line 2 City State ZIP Code
Second alternate Agent phone
Second alternate Agent email address

Designation of "Agent"