Vehicle Power of Attorney Assignment
Principal's Full Name
Address
Phone Number
Driver's License or ID#
Assigned Agent
Agent's Full Name
Address
Phone Number
Driver's License or ID#
Vehicle Information
Make
Model
Year
VIN
License Plate #
Powers Granted
Description
Effective Date & Duration
Effective Date
Expiration Date (if any)
Principal's Signature
Date
Agent's Signature
Date
Notary or Witness (if required)
Name
Signature
Date