The undersigned, ______________, of _____________________________________ (address), hereby designates __________ (name) as __________ (his or her) attorney- in-fact to represent the undersigned: (1) in maintaining an account with ___________ (bank), of ____________________________________________________________ (address), (2) in drawing negotiable instruments on this account, regardless of whether the account at the time of the presentation or honoring of the negotiable instrument is in credit to the full amount of the negotiable instrument; (3) in accepting all negotiable instruments drawn on the undersigned; (4) in indorsing and delivering for deposit with or collection by __________ (bank) all negotiable instruments; (5) and in doing everything that needs to be done as fully as the undersigned could do if personally present, with full power of substitution, to satisfy all that __________ (attorney in fact), or any lawfully appointed substitute, can do or cause to be done by virtue of __________ (his or her) appointment. __________ (Bank) is authorized to pay all negotiable instruments and to receive all negotiable instruments in payment from any holder, without inquiring as to the circumstances of the issue or the disposition of the proceeds of the negotiable instruments, whether drawn to the individual order of __________ (attorney in fact), or any substitute for __________ (attorney in fact), as payee, or indorsed to __________ (attorney in fact) as indorsee, or tendered in payment of the individual obligations of __________ (attorney in fact), or otherwise.


The following is an exemplar of the signature of __________­­___________________.

                                                                                          (attorney in fact)

This power of attorney may be revoked only by notice in writing signed by the undersigned and delivered to __________ (bank), at __________ (address), __________ (city), __________ County, __________ (state). If this power of attorney is terminated by operation of law or if any substitution is revoked without notice to __________ (bank), the undersigned, to induce __________ (bank) to act, agrees to indemnify __________ (bank) from any loss suffered or liability incurred by __________ (bank) in acting under this power of attorney, until a notice of revocation of this power of attorney has been delivered to __________ (bank).


Dated: _________________________