FORM NO.

57
Appointment of Stock Agent to Trade in Stock

AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This AGREEMENT made and entered into this ___ day of
____by and between:
(Name and personal circumstances of Principal), and
hereinafter referred to as PRINCIPAL;
—and—
(Name and personal circumstances of Agent), and
hereinafter referred to as AGENT.

WITNESSETH:
WHEREAS, the PRINCIPAL hereby appoints and
authorizes, and by these presents, APPOINTED, NAMED AND
AUTHORIZED, AGENT as his Attorney-in-Fact to buy, sell and
trade in stocks, or to enter into contracts relating to securities or
commodities, on behalf of the PRINCIPAL, under the following
terms and conditions:
1. The transactions entered into by the AGENT relating to
stocks, securities and commodities for and in behalf of the
PRINCIPAL shall be for the account and risk of the PRINCIPAL.
2. This agreement shall continue and remain in full force and
effect until terminated and revoked by the PRINCIPAL upon
written notice delivered to AGENT's office at ________________
Transactions initiated prior to the revocation shall not be affected
by such revocation; provided that AGENT informs in writing of
said transactions immediately upon receipt of the revocation.
3. AGENT shall be paid his compensation for his services
at _________________
4. This supersedes any and all authorization previously
granted by the PRINCIPAL to the AGENT.
IN WITNESS WHEREOF, we have hereunto set our hands
on the date and place mentioned above.

PRINCIPAL AGENT
SIGNED IN THE PRESENCE OF:
_________________ _______________

ACKNOWLEDGEMENT

(Signature and seal of the Notary public)