Business Brokerage, Richards Gadberry and Julia Johnston

Registration Info

Provide your details below to get started on your Power of Attorney

First Name *

Middle Name

Last Name *

Email *

Password *

Cell *

Your Contact Details

Name:

Date Of Birth *

Also known as(optional)

Are you married? *

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Yes

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No

Suffix(optional)

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Jr

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Sr

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II

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III

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Other

Gender

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Male

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Female

Your Address

Full Address: *

Address Line 1 *

Address Line 2

City *

State *

County *

Zip Code *

Your Spouse Information

Your spouse's Details

First Name: *

Middle Name *

Last Name: *

Email *

Date Of Birth *

Cell *

Suffix(optional) *

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Jr

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Sr

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II

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III

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Other

Also known as(optional)

Gender

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Male

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Female

Is Your spouse's address different than you? *

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Yes

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No

State: *

Financial Durable POA:

Provide the information of one or more individuals who will serve as your agent under the Durable Power of Attorney:

Do you want to use the same agents as your personal representative? *

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Yes

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No

Primary Agent: * Click the "+" button to add another individual.

Phone Number *

Address *

Financial Durable POA-Spouse/Partner

Primary Agent: * Click the "+" button to add another individual.

Phone Number *

Address *

Health Care POA

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Financial Durable POA? *

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Yes

✓

No

Primary Agent: * Click the "+" button to add another individual.

Phone Number *

Address *

Would you like to be an organ donor? *

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Yes﹐for transplantation purposes only

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Yes﹐for transplantation﹐education and/or research

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No

Health Care POA - Spouse/Partner

Provide health care agent to make medical conditions on your behalf

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Power of Attorney? *

✓

Yes

✓

No

Primary Agent: * Click the "+" button to add another individual.

Phone Number *

Address *

Would you like to be an organ donor? *

✓

Yes﹐for transplantation purposes only

✓

Yes﹐for transplantation﹐education and/or research

✓

No

Submission Screen

If you would like to review your responses, you can select each screen and review your answer or select the previous button which will open a print screen page. Click the “Submit” button below to be directed to a page where you will be able to pay for your estate planning documents you selected. Once you have paid for your documents, your information will be sent to our office, and you will then be prompted to schedule a phone call or Zoom meeting to review your documents with a legal professional.

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