Agency Disclosure Form
Full Name of the Client
First Name
Last Name
Property Address (If Applicable)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I, undersigned, agree with the following statements:
I have received and reviewed the explanation of the agency relationships disclosed. I understand the implications of these relationships in the real estate transaction.
I acknowledge that we have the option to seek independent representation and have been encouraged to seek legal advice if there are any concerns regarding the agency relationship.
I declare that the information provided in this form is accurate to the best of my knowledge.
Date
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Month
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Day
Year
Date
Signature
Submit
Should be Empty: