Legal Representation Authorization Form
Please complete this form to authorize legal representation.
Full Name of Client
First Name
Last Name
Date of Authorization
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Authorized Representative
First Name
Last Name
Scope of Authorization
Client Signature
Date of Signature
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: