I do hereby constitute, make, and appoint _________________________ (name) of _____________________________________________________ (address) my true and lawful attorney with full power of substitution, for me and in my name, place and stead, to vote at the ________________________________, Inc. shareholders' meeting at ____________________________________ (location) or at any adjournment thereof or at any special meeting of ____________________________________, Inc. thereafter, during the period of twelve months from the date hereof, for the election of directors and for the transaction of such other business as may properly come before said meeting, according to the number of votes I would be entitled to cast if personally present.
Witness my hand this _______ day of ____________, _____.
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.