This Power of Attorney Agreement (the "Agreement") is made and entered into on __________ (insert date) by and between the following parties:
 
Grantor: ____________________________ (insert name of grantor)
Address: ____________________________ (insert address of grantor)
 
Attorney-in-fact: ____________________________ (insert name of attorney-in-fact)
Address: ____________________________ (insert address of attorney-in-fact)
 
WHEREAS, the Grantor desires to appoint the Attorney-in-fact to act on their behalf in certain matters;
 
NOW, THEREFORE, the parties agree as follows:
 
1. Scope of authority. The Attorney-in-fact is authorized to act on behalf of the Grantor in the following matters:
 
- ____________________________ (insert specific matters in which the Attorney-in-fact is authorized to act)
 
2. Term of authority. This power of attorney shall remain in effect until ____________________________ (insert duration of authority).
 
3. Compensation. The Attorney-in-fact shall not receive any compensation for their services under this Agreement.
 
4. Limitations on authority. The Attorney-in-fact is not authorized to act on behalf of the Grantor in the following matters:
 
- ____________________________ (insert specific matters in which the Attorney-in-fact is not authorized to act)
 
5. Duties of Attorney-in-fact. The Attorney-in-fact shall act in good faith and in the best interests of the Grantor in carrying out their duties under this Agreement.
 
6. Revocation. The Grantor may revoke this power of attorney at any time by providing written notice to the Attorney-in-fact.
 
7. Governing law. This Agreement shall be governed by and construed in accordance with the laws of ____________________________ (insert governing law).
 
8. Entire agreement. This Agreement constitutes the entire agreement between the parties and supersedes all prior negotiations, understandings, and agreements between the parties.
 
9. Amendments. This Agreement may not be amended except in writing and signed by both parties.
 
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first above written.
 
Grantor: ____________________________ (insert signature of grantor)
Name: ____________________________ (insert name of grantor)
Date: ____________________________
 
Attorney-in-fact: ____________________________ (insert signature of attorney-in-fact)
Name: ____________________________ (insert name of attorney-in-fact)
Date: ____________________________