DESIGNATION OF INTERSTATE SHIPPER’S REPRESENTATIVE/AGENT
I, ____(CUSTOMER NAME)____ , do hereby designate and appoint through this special power of attorney,
____(AUTHORIZED PERSON)____as my true and lawful representative and agent in my name
and to act on behalf as the designated “shipper” in compliance with 49 USC § 13102(13), to exercise
or perform any legal act, power, duty, right or obligation whatsoever that I now have, in regard to any
part of the interstate transportation of my household goods.
Through this designation of power of attorney I grant full legal authority to my designated
representative/agent to receive, sign, endorse, accept, negotiate, acknowledge, and modify any and
all elements, terms, or conditions, of any and all bills of lading, estimates, warehouse receipts,
contracts, waivers, other instruments in writing of whatever kind as they determine necessary in my
name. I understand that I am legally bound, liable, responsible, and obligated by the actions or
omissions of my designated representative/agent through this power of attorney.