Realtor Disclosure Form
Client Information
Client's Full Name
First Name
Last Name
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Realtor's Full Name
First Name
Last Name
Real Estate Agency
Disclosure Information
Agency Relationship
Seller's Agent: The agent represents the seller and owes fiduciary duties to the seller.
Buyer's Agent: The agent represents the buyer and owes fiduciary duties to the buyer.
Dual Agent: The agent represents both the buyer and the seller. Both parties must consent.
Commission Structure
The commission is typically paid by the seller.
The commission may be shared with a buyer's agent, if applicable.
Other
Potential Conflicts of Interest
I may represent other clients with similar property interests.
I may have personal interests in the property transaction.
No known conflicts of interest.
Additional Disclosures
I am related to the buyer/seller in this transaction.
I have a financial interest in the property.
Other
Submit
Should be Empty: