Form 160 - Working With Real Estate Agents Page 4

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WORKING WITH REAL ESTATE AGENTS
Agents must retain this acknowledgment for their files.
This is not a contract
By signing, I acknowledge that the agent named below furnished a copy of this brochure and reviewed it with
me.
Buyer or Seller Name (Print or Type)
Buyer or Seller Name (Print or Type)
_____________________________________
____________________________________
Buyer or Seller Signature
Buyer or Seller Signature
Date
Date
Firm Name
Agent Name and License Number
Disclosure of Seller Subagency
(Complete, if applicable)
When showing you property and assisting you in the purchase of a property, the above agent and firm will
represent the SELLER. For more information, see “Seller's Agent Working with a Buyer” in the brochure.
_________________
Buyer's Initials Acknowledging Disclosure:
Page 4 of 4
FORM 160
NC REC 1/1/2009

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