Date:
KNOW ALL MEN BY THESE PRESENTS
That I, _______________________________________ (Grantor of Power), whose address is:
_________________________________________ ______________________________________________
have made, constituted and appointed, and by these presents do make, constitute and appoint ___________________________________ (Grantee of Power), defined below:
Address: ______________________________________________________________________________,
Telephone Number: ______________________________________,
Social Security Number: __________________________________,
Date of Birth: ___________________________________________,
my true and lawful attorney, in law and in fact, for me in my name, place and stead, to sign withdrawal documents and checks for me in my name, drawn upon moneys on deposit to my credit in The Bancorp Bank, N.A., and to endorse any and all checks drawn to my order, either for deposit to my credit or to be cashed by said attorney, with like effect as if the same where done by me in person, hereby ratifying and confirming all that the said attorney shall do therein by virtue of these presents.
Account Number:
I/We hereby agree to the rules and regulations and
amendments thereto of The Bancorp Bank, N.A. and to the terms and conditions contained on this Agreement.
Witness: ____________________________ Signature of Grantor:
______________________________
Witness: ____________________________ Signature of Grantee:
______________________________
.............................................................................................................................
AFFIRMED AND SUBSCRIBED BEFORE ME THIS _____________ DAY OF ______________________
________________________________
(Notary Public)
For fast service you may fax this form to us at 302.791.5788. This form can also be mailed to:
The Bancorp Bank, N.A.
409 Silverside Road, Suite 105
Wilmington, DE 19809
Banking Services provided by The Bancorp Bank. Member FDIC. Equal Housing Lender