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Proxy Consent

Complete this form to build a Proxy Consent.

Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.

Stockholder:
(Stockholder's Name)
Corporation:
(Name of corporation in which you own stock)
Proxy:
(Name of person you want to act as a proxy)
Expiration Date://
(Select the month, day and year the proxy expires)
State/Province and Country:
(Select state/province and country in which proxy is being signed)
Date Signed://
(Select the month, day and year the document will be signed)
Witness:
(Witness's name)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.

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