SELLER MANDATE ATTESTATION 

I, _____________________________, attest, under PENALTY OF PERJURY of law, that I have authorization to submit this product and that I have on file an NCND and LOI, both signed by the seller within the past 96 hours for this transaction.  

Portfolio Description:_________________________________________________ 

(Initial applicable item below) 

____ I am a mandate to the seller with written authority to sign and/or act on behalf of the seller for this transaction. 

____ I am a mandate to the seller without signatory authority.  I do not have written authority to sign and/or act on behalf of the seller for this transaction. 

____ I am not a direct mandate, but I have written authorization to submit this package on behalf of the seller.    

Name:______________________________________________________ 

Signature: ______________________________   Date: ______________________ 

Contact Info: 

Company: __________________________________________________________ 

Address:____________________________________________________________
Phone:_______________________________  Fax:__________________________ 

Email:______________________________________________

 

Sellers Name:_______________________ 

_______________________________ 

Sellers Signature 

NOTE:  Attach NCND to this order and return to: 

________________________________________ 

________________________________________ 

Email:  _________________________________ 

Phone: _________________________________ 

Fax: ___________________________________