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UPDATED: 5/7/05

Power of Attorney Form

This information will be used to prepare a customs power of attorney form, as explained on the previous page. Upon receipt of this information we will send you the form for execution by an authorized person in the format you request.

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Company Name

Federal Tax ID or EIN / SSN

Type of Business

State of Incorporation

Street Address  

City State Zip Code

Please send form to us via

Telephone #

Fax #

E-mail address


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Revised: December 07, 2005
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