Windows Internet Explorer© is required to properly see and complete the power of attorney.
Once this form is completed and checked for accuracy, please print a copy and have signed by the appropriate party. Then fax a copy to (310)216-1545 and mail the original to David W. Bailey CHB at P.O. Box 91172, Los Angeles, CA 90009.
1. Check appropriate box.
Individual: Check if you have a non commercial shipment.
Partnership: A power of attorney for a partnership is valid
for no more than two years.
Corporation: This includes LLC's, Limited Liability
Corporation.
Sole Proprietorship: Individuals who are operating a
commercial business with or without a dba (doing business as),
will check sole proprietorship.)
2. Federal I.D. or Social Security Number
If you are a corporation, please indicate your Federal
I.D. number. This is also known as your Tax I.D. or FEIN number
(Federal
Employer Identification Number). If you are other than a corporation, please
indicate your Social Security
number. Partnership, please put a check mark by
the partner's name who's social security number is being used.
3. Name of Corporation, Individual,
Partnership, or Sole Proprietorship.
Corporations: Please put the complete legal name of the
corporation.
Partnerships: Please put the full legal names of all the
partners and the name of the partnership.
For example, John Doe and Mary Doe dba ABC Enterprises.
Sole Proprietorships: Please put the full legal name of the
owner and the (dba).
Example, John Doe dba ABC Enterprises
Individual: Please put your full legal name.
4. State where Incorporated
(Corporations Only).
Please put the name of the State where the company was
incorporated. If not a corporation, please leave blank.
5. To be used when a Partnership,
Individual or Sole Proprietorship.
Use this space only if you are an individual, a
partnership or a sole proprietorship indicating which.
6. Doing business as.
If you are a corporation, a partnership or a sole proprietorship
using a dba, please
put it here.
7. Residence address.
This space is only used by individuals to show their
residence address. P.O. Box's are not accepted.
8. Business address.
This space is used to show the complete address of the
corporation, partnership, or sole proprietorship. P.O. Box's
are not accepted.
9. Full legal name.
Please put the full legal name of the person signing this
form. Only one officer, partner, owner or individual need sign.
10. Legible signature.
Please sign legibly with a black or blue
ballpoint pen. Please do not use a felt pen.
11. Capacity.
Corporation: Only the following persons are allowed to
sign a power of attorney on behalf of the corporation:
Any executive officer, i.e. Chairman of the Board, CEO, CFO, COO, President,
Vice President,
Treasurer or Secretary of the Corporation.
Partnership: Only one partner's signature is
required and the word "Partner" should be put as capacity.
Sole Proprietorship: The owner will sign the form
and show his or her capacity as "Owner".
Individual: The named party will sign this form
and show his or her capacity as "Individual"
12. Date.
Put the date the form is signed.