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Power of Attorney
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Indicates required field
I __________, the undersigned,
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First
Last
, do hereby grant to _______________,
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of __________________
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Located at __________, as my attorney-in-fact, to receive on my behalf information from Direct Shipper and Property Brakers, and to sign freight rate confirmation on my behalf pertaining to such information:
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City
State
Zip Code
Country
The power of attorney will expire in twelve months from the date signed.
Signature of Motor Carrier (Enter name)
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Address of Motor Carrier
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City
State
Zip Code
Country
MC# of Motor Carrier
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The affiant being duly sworn affirms and says that he or she is the signer(s) of the forgoing power of attorney, and that he or she has read the forgoing power of attorney and the understands its content.
Motor Carrier Name
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Authorized Party:
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Signature (Enter Name)
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Date (##-##-####)
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Email
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