Select whether authorized person is authorized* for Entity + all Affiliates named in Section X, or Entity + only as desi *If person is authorized to act for the Entity only and not authorized to act on behalf of any Affiliates, then leave the Affiliate column(s) blank for t
PRESIDENT ☐ ☐ ☑
GERALD SHIELDS
VICE PRESIDENT ☐ ☐ ☑ ☑
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Title of Authorized Person Entity + All Affiliates Entity + Designated Affiliates ONLY DDA/TM Com Card
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RONALD JOHNSON
☐ ☐ ☐ ☐
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Name of Authorized Person
Add the name and title of the person(s) authorized for the Entity
Select the product for which each authorized person(s) is/are authorized
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