2015-16 CWB
Producer authorization - Producer car loading sites
This document indicates the producer’s authorization for the following producer car loading site to transact
business on the producer’s behalf for CWB contract programs. This document must be signed by both the
producer and the loading site acting on the producer’s behalf. The loading site must retain a copy of this
document on file for the duration of this authorization.
Producer information
Customer No. (12345678)
Name
Home phone No.
Cell phone No.
Fax No.
E-mail
I (the Producer) ____________________________________________hereby authorize (the producer car
loading site) _____________________________________________ to transact business (e.g. sign up or lock
in a price) with CWB over the telephone for CWB contract programs. I request that CWB release, disclose and/
or communicate my personal business information relative to my CWB contracts to officers and employees of
the following organization(s) (the “Authorized Company”): _______________________________________and
to the following individual(s) _________________________________________________________________
________________________________________________________________________________________.
This Authorization shall be effective on the date first written below and shall continue for a period of three (3)
years from the date hereof unless earlier terminated by written notice of the undersigned. This Authorization
shall constitute the consent of the undersigned to the release of the above noted information, pursuant to the
provisions contained within the Privacy Act.
Date (month/day/year)
Producer signature
Authorized company signature
Date (month/day/year)
Important - please keep the original for your records.
Effective April 6, 2015