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Application for Power of Attorney

Use this application if you want to be able to legally act as an "Agent" for another person in case that person cannot make decisions for themselves. You can either set up a Power of Attorney for Financial decisions, Medical decisions, or both, which will require two separate Powers of Attorney.

Name of person ordering Power of Attorney (POA)(Required)

Please read this first. Regarding a Power of Attorney, the person that is representing another person is the "Attorney in Fact", or "Agent". The person that is being represented is the "Principal".

Phone Number of person ordering Power of Attorney(Required)

Email Address

Who will be the person that is going to be acting as the "Attorney-In-Fact", or "Agent"?(Required)

The person that will be making decisions. List any alternate attorneys-in-fact. (Not required)

Name of person who will be the Principal (The person that will need someone to make decisions for them)(Required)

The person that will need someone to make decisions for them.

Type of Power of Attorney

The financial power of attorney cannot be used for healthcare.

Financial - General/Durable

Healthcare - Medical

Additional Information