Order Form
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Section: # of docs
How many Durable Powers of Attorney (DPOAs) do you want to order (each is $50)?
*
How many HealthCare Directives do you want to order (each is $50)?
*
Total Cost in US Dollars is shown below. We will ask later for your payment details.
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Section: DPOA 1 - Principal & Agent + powers & auths
We will be asking you for various information for each DPOA you plan to purchase. Each DPOA *must* have the name and address of the Principal and Agent; everything else we will be asking you is optional, but may be to your benefit. At the end, we will ask you for your payment method.
A "Principal" is the person who blah, blah, blah. An "Agent" is the person who blah, blah, blah.
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Let's begin by asking you some questions for the first DPOA, starting off with the Principal.
The "Principal" is the person who blah, blah, blah.
For DPOA #1, what is the legal name of the Principal?
*
First Name
Last Name
Suffix
For DPOA #1, what is the address of the Principal?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #1, what is the phone number of the Principal?
-
Area Code
Phone Number
For DPOA #1, what is the email address of the Principal?
example@example.com
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Now, let's focus on the Agent for the first DPOA.
The "Agent" is the person who blah, blah, blah.
For DPOA #1, what is the name of the Agent?
*
First Name
Last Name
Suffix
For DPOA #1, what is the address of the Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #1, what is the phone number of the Agent?
-
Area Code
Phone Number
For DPOA #1, what is the email address of the Agent?
example@example.com
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For DPOA #1, which of these powers, if any, does the Principal want to restrict from the Agent?
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For DPOA #1, which of these, if any, does the Principal want to authorize the Agent?
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Section: DPOA 1: backup Agent needed?
For DPOA #1, would the Principal like to have a backup Agent?
Yes
No
Section: DPOA 1 - backup Agent info
For DPOA #1, what is the name of the backup Agent?
*
First Name
Last Name
Suffix
For DPOA #1, what is the address of the backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #1, what is the phone number of the backup Agent?
-
Area Code
Phone Number
For DPOA #1, what is the email address of the backup Agent?
example@example.com
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Section: DPOA 1: second backup Agent needed?
For DPOA #1, would the Principal like to have a second backup Agent?
Yes
No
Section: DPOA 1 - second backup Agent
For DPOA #1, what is the name of the second backup Agent?
*
First Name
Last Name
Suffix
For DPOA #1, what is the address of the second backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #1, what is the phone number of the second backup Agent?
-
Area Code
Phone Number
For DPOA #1, what is the email address of the second backup Agent?
example@example.com
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Section: DPOA 1: Conservator nominee needed?
For DPOA #1, would the Principal like to nominate a Conservator, in the event the court appoints one?
Yes
No
Section: DPOA 1 - DPOA 1: Conservator nominee
For DPOA #1, what is the name of your nominee to be Conservator?
*
First Name
Last Name
Suffix
For DPOA #1, what is the address of your nominee to be Conservator?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #1, what is the phone number of your nominee to be Conservator?
-
Area Code
Phone Number
For DPOA #1, what is the email address of your nominee to be Conservator?
example@example.com
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DPOAs = 1
Section: DPOA 2 - Principal & Agent + powers & auths
Next, we will ask you some questions about the second DPOA, again starting off with the Principal.
The "Principal" is the person who blah, blah, blah.
For DPOA #2, what is the legal name of the Principal?
*
First Name
Last Name
Suffix
For DPOA #2, what is the address of the Principal?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #2, what is the phone number of the Principal?
-
Area Code
Phone Number
For DPOA #2, what is the email address of the Principal?
example@example.com
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Now, let's focus on the Agent for the second DPOA.
The "Agent" is the person who blah, blah, blah.
For DPOA #2, what is the name of the Agent?
*
First Name
Last Name
Suffix
For DPOA #2, what is the address of the Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #2, what is the phone number of the Agent?
-
Area Code
Phone Number
For DPOA #2, what is the email address of the Agent?
example@example.com
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For DPOA #2, which of these powers, if any, does the Principal want to restrict from the Agent?
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For DPOA #2, which of these, if any, does the Principal want to authorize the Agent?
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Section: DPOA 2: backup Agent needed?
For DPOA #2, would the Principal like to have a backup Agent?
Yes
No
Section: DPOA 2 - backup Agent
For DPOA #2, what is the name of the backup Agent?
*
First Name
Last Name
Suffix
For DPOA #2, what is the address of the backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #2, what is the phone number of the backup Agent?
-
Area Code
Phone Number
For DPOA #2, what is the email address of the backup Agent?
example@example.com
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Section: DPOA 2: second backup Agent needed?
For DPOA #2, would the Principal like to have a second backup Agent?
Yes
No
Section: DPOA 2 - second backup Agent
For DPOA #2, what is the name of the second backup Agent?
*
First Name
Last Name
Suffix
For DPOA #2, what is the address of the second backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #2, what is the phone number of the second backup Agent?
-
Area Code
Phone Number
For DPOA #2, what is the email address of the second backup Agent?
example@example.com
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Section: DPOA 2: Conservator nominee needed?
For DPOA #2, would the Principal like to nominate a Conservator, in the event the court appoints one?
Yes
No
Section: DPOA 2 - Conservator nominee
For DPOA #2, what is the name of your nominee to be Conservator?
*
First Name
Last Name
Suffix
For DPOA #2, what is the address of your nominee to be Conservator?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #2, what is the phone number of your nominee to be Conservator?
-
Area Code
Phone Number
For DPOA #2, what is the email address of your nominee to be Conservator?
example@example.com
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DPOAs = 2
Section: DPOA 3 - Principal & Agent + powers & auths
Now, let's move on to the third DPOA.
For DPOA #3, what is the legal name of the Principal?
*
First Name
Last Name
Suffix
For DPOA #3, what is the address of the Principal?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #3, what is the phone number of the Principal?
-
Area Code
Phone Number
For DPOA #3, what is the email address of the Principal?
example@example.com
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For DPOA #3, what is the name of the Agent?
*
First Name
Last Name
Suffix
For DPOA #3, what is the address of the Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #3, what is the phone number of the Agent?
-
Area Code
Phone Number
For DPOA #3, what is the email address of the Agent?
example@example.com
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For DPOA #3, which of these powers, if any, does the Principal want to restrict from the Agent?
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For DPOA #3, which of these, if any, does the Principal want to authorize the Agent?
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Section: DPOA 3: backup Agent needed?
For DPOA #3, would the Principal like to have a backup Agent?
Yes
No
Section: DPOA 3 - backup Agent
For DPOA #3, what is the name of the backup Agent?
*
First Name
Last Name
Suffix
For DPOA #3, what is the address of the backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #3, what is the phone number of the backup Agent?
-
Area Code
Phone Number
For DPOA #3, what is the email address of the backup Agent?
example@example.com
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Section: DPOA 3: second backup Agent needed?
For DPOA #3, would the Principal like to have a second backup Agent?
Yes
No
Section: DPOA 3 - second backup Agent
For DPOA #3, what is the name of the second backup Agent?
*
First Name
Last Name
Suffix
For DPOA #3, what is the address of the second backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #3, what is the phone number of the second backup Agent?
-
Area Code
Phone Number
For DPOA #3, what is the email address of the second backup Agent?
example@example.com
Back
Next
Section: DPOA 3: Conservator nominee needed?
For DPOA #3, would the Principal like to nominate a Conservator, in the event the court appoints one?
Yes
No
Section: DPOA 3 - Conservator nominee
For DPOA #3, what is the name of your nominee to be Conservator?
*
First Name
Last Name
Suffix
For DPOA #3, what is the address of your nominee to be Conservator?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #3, what is the phone number of your nominee to be Conservator?
-
Area Code
Phone Number
For DPOA #3, what is the email address of your nominee to be Conservator?
example@example.com
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DPOAs = 3
Section: DPOA 4 - Principal & Agent + powers & auths
Okay, now the questions for the fourth DPOA.
For DPOA #4, what is the legal name of the Principal?
*
First Name
Last Name
Suffix
For DPOA #4, what is the address of the Principal?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #4, what is the phone number of the Principal?
-
Area Code
Phone Number
For DPOA #4, what is the email address of the Principal?
example@example.com
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Next
For DPOA #4, what is the name of the Agent?
*
First Name
Last Name
Suffix
For DPOA #4, what is the address of the Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #4, what is the phone number of the Agent?
-
Area Code
Phone Number
For DPOA #4, what is the email address of the Agent?
example@example.com
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Next
For DPOA #4, which of these powers, if any, does the Principal want to restrict from the Agent?
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Next
For DPOA #4, which of these, if any, does the Principal want to authorize the Agent?
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Next
Section: DPOA 4: backup Agent needed?
For DPOA #4, would the Principal like to have a backup Agent?
Yes
No
Section: DPOA 4 - backup Agent
For DPOA #4, what is the name of the backup Agent?
*
First Name
Last Name
Suffix
For DPOA #4, what is the address of the backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #4, what is the phone number of the backup Agent?
-
Area Code
Phone Number
For DPOA #4, what is the email address of the backup Agent?
example@example.com
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Section: DPOA 4: second backup Agent needed?
For DPOA #4, would the Principal like to have a second backup Agent?
Yes
No
Section: DPOA 4 - second backup Agent
For DPOA #4, what is the name of the second backup Agent?
*
First Name
Last Name
Suffix
For DPOA #4, what is the address of the second backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #4, what is the phone number of the second backup Agent?
-
Area Code
Phone Number
For DPOA #4, what is the email address of the second backup Agent?
example@example.com
Back
Next
Section: DPOA 4: Conservator nominee needed?
For DPOA #4, would the Principal like to nominate a Conservator, in the event the court appoints one?
Yes
No
Section: DPOA 4 - Conservator nominee
For DPOA #4, what is the name of your nominee to be Conservator?
*
First Name
Last Name
Suffix
For DPOA #4, what is the address of your nominee to be Conservator?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #4, what is the phone number of your nominee to be Conservator?
-
Area Code
Phone Number
For DPOA #4, what is the email address of your nominee to be Conservator?
example@example.com
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DPOAs = 4
Section: DPOA 5 - Principal & Agent + powers & auths
And finally, let's ask you about the fifth DPOA.
For DPOA #5, what is the legal name of the Principal?
*
First Name
Last Name
Suffix
For DPOA #5, what is the address of the Principal?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #5, what is the phone number of the Principal?
-
Area Code
Phone Number
For DPOA #5, what is the email address of the Principal?
example@example.com
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Next
For DPOA #5, what is the name of the Agent?
*
First Name
Last Name
Suffix
For DPOA #5, what is the address of the Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #5, what is the phone number of the Agent?
-
Area Code
Phone Number
For DPOA #5, what is the email address of the Agent?
example@example.com
Back
Next
For DPOA #5, which of these powers, if any, does the Principal want to restrict from the Agent?
Back
Next
For DPOA #5, which of these, if any, does the Principal want to authorize the Agent?
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Next
Section: DPOA 5: backup Agent needed?
For DPOA #5, would the Principal like to have a backup Agent?
Yes
No
Section: DPOA 5 - backup Agent
For DPOA #5, what is the name of the backup Agent?
*
First Name
Last Name
Suffix
For DPOA #5, what is the address of the backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #5, what is the phone number of the backup Agent?
-
Area Code
Phone Number
For DPOA #5, what is the email address of the backup Agent?
example@example.com
Back
Next
Section: DPOA 5: second backup Agent needed?
For DPOA #5, would the Principal like to have a second backup Agent?
Yes
No
Section: DPOA 5 - second backup Agent
For DPOA #5, what is the name of the second backup Agent?
*
First Name
Last Name
Suffix
For DPOA #5, what is the address of the second backup Agent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #5, what is the phone number of the second backup Agent?
-
Area Code
Phone Number
For DPOA #5, what is the email address of the second backup Agent?
example@example.com
Back
Next
Section: DPOA 5: Conservator nominee needed?
For DPOA #5, would the Principal like to nominate a Conservator, in the event the court appoints one?
Yes
No
Section: DPOA 5 - Conservator nominee
For DPOA #5, what is the name of your nominee to be Conservator?
*
First Name
Last Name
Suffix
For DPOA #5, what is the address of your nominee to be Conservator?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For DPOA #5, what is the phone number of your nominee to be Conservator?
-
Area Code
Phone Number
For DPOA #5, what is the email address of your nominee to be Conservator?
example@example.com
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Section: Checkout
That's all the information we need to create your legal documents. Your total amount due is:
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What email address should we send your receipt and legal documents?
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example@example.com
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