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General Proxy
GENERAL PROXY
The undersigned , being a stockholder of [Name of Corporation], hereinafter "Corporation", does hereby grant and confer power of attorney and proxy upon [Name of attorney] to represent the undersigned at any and all regular and special meetings of the shareholders of said Corporation. This power of attorney and proxy shall exist for a duration of time not extending beyond [Last date power of attorney is valid].
Said agent will not be limited in exercising all of the rights and privileges as I would regularly enjoy as pertains to voting, discussion, or any other matter arising for consideration and action during business of said meetings, acting on my behalf.
Signed Date
Witness Date