Authorization To Execute Contract Documents On My Behalf

1. I wish to become contracted and/or appointed with American Classic Agency, Corp. ("ACA"), and the life insurance companies ("the ACA Carriers") listed in paragraph 3, below, for which it is a marketing organization. I have filled out and electronically signed and submitted an ACT Appointment Data Sheet containing information required to complete the documents listed in paragraphs 2 and below (collectively "the Contract Documents") and to determine whether I qualify for appointment by the ACA Carriers. I understand that all such contracts and appointments are subject to the approval of ACA and the applicable ACA Carriers, to ACAs execution of the ACA Documents (defined below) and to my appointment by the applicable ACA Carriers.
2. In order to be contracted with ACA, I have to execute the following documents, in addition to the ACA Data Sheet I have already electronically executed ("the ACA Documents"): Sales Representative Agreement, ACA Security Agreement.
3. In order to be contracted with and appointed by each of the following life insurance companies, I have to complete and execute the standard forms they require in order to contract or appoint an independent agent ("the Insurer Documents"): National Life Insurance Company, Life Insurance Company of the Southwest, Mutual of Omaha Insurance Company, United of Omaha Life Insurance Company, United World Life Insurance Company, Companion Life Insurance Company, Americo Financial Life and Annuity Insurance Company, Mutual Trust Life, and Great Southern Life Insurance Company.
4. I authorize an individual of ACA designated by it to, on my behalf, (i) complete each of the ACA Documents and each of the Insurer Documents on the basis of information I have provided in the ACT Appointment Data Sheet and (ii) electronically sign each of such Documents. I agree that each of such documents so completed and so signed shall be legally binding on me, just as if I had myself completed and signed it. This authorization is limited to the documents required for my initially being contracted with and/or appointed by ACA and each of the ACA Insurers, and does not extend to any subsequent changes or amendments to any of the Contract Documents or to the termination of any of them.
5. I understand that I will have access to an electronic copy of each of the ACA Documents and of each Insurer Document completed and executed by ACA on my behalf. When I am notified by email that such access is available, I will promptly use it to review such documents, and will advise ACA by letter or email if there are any errors in any of them, or if I have any objection to any part of them. I understand that I will be legally bound by such documents once they are accepted by ACA and by the respective insurers.
6. If the ACT Appointment Data Sheet indicates that the contracts and appointments are to be in the name of a corporation, partnership or other business entity, the word "I" in this Authorization means both the entity and the individual completing this Authorization. In such case, both the entity’s name and the individual’s name should be electronically signed as set forth below.
Entering my name (and the name of my corporation or other entity, if any) below, following the word "Signature" constitutes my electronic signature and is intended by me to legally bind me to this agreement and to each of the Contract Documents which ACA completes and electronically signs on my behalf.