Form Ad Ag 0455B PDF Details

The Agricultural Marketing Service (AMS) Form Ad Ag 0455B is a commodity complaint form used to report allegations of unfair or deceptive practices in the marketing of agricultural commodities. The form can be used to file complaints against buyers, sellers, handlers, processors, and others involved in the marketing of agricultural commodities. Complaints filed using this form may help protect the interests of producers and consumers alike. If you believe that you have been a victim of unfair or deceptive trade practices, be sure to fill out and submit Form Ad Ag 0455B.

QuestionAnswer
Form NameForm Ad Ag 0455B
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesCertifying, revocation, 2010, designating

Form Preview Example

AUTHORIZATION AND AGREEMENT FOR TREASURY SERVICES

I am an authorized representative of the organization specified below (the “Client”). The Client has received Bank of America’s Treasury Services Terms and Conditions Booklet (the “Booklet”) in the form and with the content posted on the website of Bank of America and agrees to adhere to the Booklet and any applicable User Documentation from Bank of America (“Bank”). The Services covered by the Booklet and the banks providing Services are listed on the accompanying List of Banks and Services, which we may change from time to time. Capitalized terms used in this Authorization and Agreement form, not otherwise defined, have the meanings given to them in the Booklet.

After I sign below on behalf of the Client, the Client may from time to time request the Bank to provide any of the Services described in the Booklet. The Client may begin to use any such Service once Bank has approved such use and has received all required and properly executed forms and the Client has successfully completed any testing or training requirements. The Booklet supersedes other agreements between the Client and the Bank, as described under the General Matters heading in the Booklet, with regard to the provision of Services.

I warrant that the Client has taken all action required by its organizational or constituent documents to authorize me to execute and deliver on behalf of the Client this Authorization and Agreement form and any other documents the Bank may require with respect to a Service. I am authorized to enter into all transactions contemplated by the provision of Services to the Client. These may include, but are not limited to, giving the Bank instructions with regard to Electronic Funds Transfer Services and designating employees or agents to act in the name and on behalf of the Client.

Guidelines for completion:

 

If Client is a:

Who must sign:

corporation

any authorized officer

limited liability company

all members, or any authorized officer*

partnership (general or limited)

any general partner’

limited liability partnership

the managing partner*

sole proprietorship

the sole proprietor

governmental entity

the Treasurer*

*Includes any individual authorized under Client’s charter or organizational or constituent documents. The legal name of any member, managing member, manager or general partner who is signing and who is not an individual must appear in the signature block. Note that in most cases the Client must also complete the

Certification form which follows.

(ORGANIZATION’S/CLIENTS LEGAL NAME)

[Signature of Authorized Representative]

[Print Name of Authorized Representative]

[Print Title of Authorized Representative (include the legal name of any member, managing member, manager or general partner who is signing and who is not an individual)]

The following addresses may be used for giving notices in connection with this Booklet except as you or we provide the other different addresses to be used in conjunction with your accounts or particular Services.

Address for Client Notices:

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

Telephone: ( ) _____________________________________________

Fax: ( ) ___________________________________________________

Dated

[Signature of Authorized Representative, if two are required by Client]

[Print Name of Authorized Representative]

[Print Title of Authorized Representative (include the legal name of any member, managing member, manager or general partner who is signing and who is not an individual)]

Address(es) for Bank Notices: Bank of America, N.A.

Documentation Management (CA4.706-04-07) P.O. Box 27128

Concord, CA 94527-9904

Fax No.: (925) 675-7131

and, if filled in; the following:

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

Telephone: ( ) ________________________________________

Fax: ( ) _________________________________________

AD-AG-0455B (2004-2)

1

AUTHORIZATION AND AGREEMENT CERTIFICATION

I certify that each signature appearing on the previous page for Client is the true signature of a person authorized to execute the form on behalf of Client, and I further certify that I have full authority to execute this certification. The Bank is entitled to rely upon this certification until written notice of its revocation is delivered to the Bank.

Guidelines for completion: This Certification should not be signed by the individual who signed the Authorization and Agreement.

If Client is a:

Who must sign:

corporation

any authorized officer

limited liability company

any member or authorized officer

limited liability partnership

any partner

partnership (general or limited)

any general partner

sole proprietorship

no signature required

 

governmental entity the entity’s counsel, or any other individual

 

as permitted by •the entity’s organizational documents

The legal name of any member, managing member, manager or general partner who is signing and who is not an individual must appear in the signature block.

Note: If Client is not a U.S. based entity, it is not required to complete this certification, but must provide authorizing certificates or mandates.

Dated

(ORGANIZATION’S/CLIENT’S LEGAL NAME)

 

 

 

 

‘Signature of Certifying Representative]

 

 

 

 

 

[Print Name of Certifying Representative]

 

 

[Print Title of Certifying Representative (include the legal name of any

 

 

member, managing member, manager or general partner who is signing

 

 

and who is not an individual)]

AD-AG-0455B (2004-2)

2

TREASURY SERVICES DELEGATION OF AUTHORITY FORM

This form is optional and is to be used when you wish to delegate authority to sign various authorization forms to someone other than the person who signed the Authorization and Agreement form in the front of this Booklet.

By signing below, you authorize the incumbent of the specified position listed in Section A or each person listed in section B below, acting alone, to execute documents that we may request, and any amendments or renewals thereof, pertaining to the use of Services, including but not limited to designating one or more persons (which may include himself or herself) authorized to initiate, amend, cancel, confirm or verify the authenticity of instructions to us for Services, whether given orally, electronically or by facsimile instructions, and to revoke any authorization granted to any such person, as he or she deems appropriate. The signer of this form has the same authority described above for each Service with us, unless otherwise specified. We are entitled to rely upon this delegation until written notice of its revocation is received by us.

Guidelines for Completion: Fill out either section A or section B, or both, depending on your needs.

To delegate authority to any person holding a specific title, fill out section A.

To delegate authority to specific individuals by name, fill out section B.

For each name or title, indicate “All” in the “Service” column if the person or title has authority to sign documents for all Services which you receive from us. Otherwise, indicate specific Services for which the person or title has authority. For each name or title, indicate the entity or entities for which the person or title has authority to sign documents.

A. TO DELEGATE AUTHORITY TO ANY PERSON HOLDING SPECIFIC POSITIONS

Title

Service

Entity

 

 

 

 

 

 

 

 

 

 

 

 

B. TO DELEGATE AUTHORITY TO SPECIFIC INDIVIDUALS

Name

Service

Entity

Specimen Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLIENT AUTHORIZATION

Client Authorization Instructions: The same person who signed the Authorization and Agreement for TREASURY SERVICES form must SIGN this Treasury Services Delegation of Authority form.

Dated

(ORGANIZATION’S/CLIENTS LEGAL NAME)

[Signature of Authorized Representative]

[Print Name of Authorized Representative]

[Print Title (include the legal name of any member, managing member, manager or general partner who is signing and who is not an individual)]

AD-AG-0455B (2004-2)

3