Partner Agency Signature authorization form

Agency Signature Authorization form

This form is to be used solely for the purpose to cross reference persons authorized to sign on behalf of the agency for product received from NTFB. If you are using this form then you can sign electronically with stylus, finger tip, or mouse.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Agency Name (typed or printed)
Executive Director (typed or printed)

First NameLast Name
Current method of receiving product: (select one)
These persons are authorized to sign invoices acknowledging receipt of product: (up to 5 signature specimens)
Typed or Printed name:

First NameLast Name
Signature
Typed or Printed name:

First NameLast Name
Signature
Typed or Printed name:

First NameLast Name
Signature
Typed or Printed name:

First NameLast Name
Signature
Typed or Printed name:

First NameLast Name
Signature
On behalf agency listed above, I hereby authorize the persons listed above to sign NTFB invoices accepting product.
Executive Director Signature
Should be Empty:

Agency Signature Authorization form