Financial power of attorney (POA)

Your Name*
First Middle Last
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.
Designation of Primary Agent
Do you wish to have your spouse act as your primary agent?
- Yes
- No
If you are not married, please select "no".
Provide the full name of your primary agent
First Middle Last
This is the first person that you authorize to make financial decisions on your behalf
Primary agent address
Street Address Address Line 2 City State ZIP Code
Primary agent phone
Primary agent email address

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Designation of Alternate Agents
Provide the full name of your first alternate agent
First Middle Last
If the first person you named is not able to act, this person will serve as an alternate.
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 in your financial power of attorney?
- Yes
- No
Provide the full name of your second alternate agent
First Middle Last
Second alternate agent address
Street Address Address Line 2 City State ZIP Code
Second alternate agent phone
Second alternate agent email address

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Compensation of Agent
Agents are typically reimbursed for all reasonable expenses, and/or are paid for the services rendered while acting as your agent.
Which of the following statements best describes your wishes?
- I wish to reimburse reasonable expenses and provide reasonable compensation for services in fact provided by my agent.
- I wish to reimburse reasonable expenses incurred by my agent.
- I do not wish to reimburse either expenses or compensate for services provided by my agent.

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Designation of Primary Agent