Brokerage Disclosure Template (Page 2 of 2) in pdf

Brokerage Disclosure Template Page 2

CHECK ONE BOX ONLY:



Customer. Broker is the seller’s agent and Buyer is a customer. Broker, as seller’s agent, intends to perform the

following list of tasks:  Show a property  Prepare and Convey written offers, counteroffers and agreements to amend

or extend the contract. Broker is not the agent of Buyer.



Customer for Broker’s Listings – Transaction-Brokerage for Other Properties. When Broker is the seller’s

agent, Buyer is a customer. When Broker is not the seller’s agent, Broker is a transaction-broker assisting in the transaction.

Broker is not the agent of Buyer.



Transaction-Brokerage Only. Broker is a transaction-broker assisting in the transaction. Broker is not the agent of

Buyer.

Buyer consents to Broker’s disclosure of Buyer’s confidential information to the supervising broker or designee for the

purpose of proper supervision, provided such supervising broker or designee shall not further disclose such information

without consent of Buyer, or use such information to the detriment of Buyer.

DISCLOSURE OF SETTLEMENT SERVICE COSTS. Buyer acknowledges that costs, quality, and extent of service

vary between different settlement service providers (e.g., attorneys, lenders, inspectors and title companies).

THIS IS NOT A CONTRACT.

If this is a residential transaction, the following provision shall apply:

MEGAN’S LAW. If the presence of a registered sex offender is a matter of concern to Buyer, Buyer understands that

Buyer must contact local law enforcement officials regarding obtaining such information.

BUYER ACKNOWLEDGMENT:

Buyer acknowledges receipt of this document on

Buyer

BROKER ACKNOWLEDGMENT:

, Broker provided

(Buyer) with

this document via

and retained a copy for Broker’s records.

Brokerage Firm’s Name:

Broker

Clear Form

BD24-5-09. BROKERAGE DISCLOSURE TO BUYER/TENANT

Page 2 of 2

Brokerage Disclosure Template Page 2