KNOW ALL MEN BY THESE PRESENTS:
That I/we , (Name of individual, partnership, corporation, or sole proprietorship)
hereby constitute and appoint
(Name of customs broker)
to act as my/our true and lawful agent and attorney in fact, to act for and on my/our behalf for Customs business as fully as I/we could do if personally present, and to receive, endorse, and collect checks issued for customs duty refunds, in accordance with Title 19, United States Code, Section 1641.
Individual Partnership Corporation Sole Proprietor
If a corporation, the signer certifies that he/she has authority to sign this power of attorney.