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Address of Property
Owner's First & Last Name
Agent's First & Last Name
P.O. Box Not Acceptable
By checking the "I agree" box below, I/we authorize my/our aforementioned agent to act on my/our behalf as my/our registered agent, and assume all of the duties listed above. However, I/we understand that as the legal owner(s) of this property I/we will be responsible for the actions/and or infractions of the agent listed above.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
* indicates a required field