Disclosure Regarding Real Estate Agency Relationships
DUAL AGENTS
A real estate licensee can be the agent of both the seller and the buyer in a transaction, but only with the knowledge and informed consent, in writing, of both the seller and the buyer. In such a dual agency situation, the licensee will not be able to disclose all known information to either the seller or the buyer. As a dual agent, the licensee will not be able to provide the full range of fiduciary duties to the seller or the buyer. The obligations of a dual agent are subject to any specific provisions set forth in any agreement between the dual agent, the seller and the buyer.
TRANSACTION COORDINATOR
A transaction coordinator is a licensee who is not acting as an agent of either the seller or the buyer, yet is providing services to complete a real estate transaction. The transaction coordinator is not an agent for either party and therefore owes no fiduciary duty to either party.
DESIGNATED AGENCY
A buyer or seller with a designated agency agreement is represented only by agents specifically named in the agreement. Any agents of the firm not named in the agreement do not represent the buyer or seller. The named "designated" agent acts solely on behalf of his or her client and may only share confidential information about the client with the agent's supervisory broker who is also named in the agreement. Other agents in the firm have no duties to the buyer or seller and may act solely on behalf of another party in the transaction.
LICENSEE DISCLOSURE REALTOR hereby discloses the following relationship: (check one from each column)
with the SELLER ex ) Seller's Agent
with the BUYER ( ) Buyer's Agent
( ) Buyer's Agent -Limited Service Agreement ( ) Dual Agent
( ) Seller's Agent ~ Limited Service Agreement ( ) Dual Agent
AND
( ) Transaction Coordinator (x ) None of the Above
( ) Transaction Coordinator ( ) None of the Above
AFFILIATED LICENSEE DISCLOSURE (Check one) __ Check here if acting as a designated agent. Only the licensee's broker and a named supervisory broker have the same agency relationship as the licensee named below. If the other party in a transaction is represented by an affiliated licensee, then the licensee's broker and all named supervisory brokers shall be considered disclosed consensual dual agents. _ _ Check here if not acting as a designated agent. All affiliated licensees have the samc agency relationship as the licensee named below.
r vided to the buyer or seller before disclosure of any confidential information.
1'L-/~'2-3
Licensee
Date
Date
Licensee
ACKNOWLEDGMENT
By signing below, the parties acknowledge that they have received and read the information in lhis agency disclosure statement and acknowledge that this form was provided to them before the disclosure of any confidential information specific to the potential sellers or buyers. THIS IS NOT A CONTRACT, The undersigned __ Does _x __ Does Not have an agency relationship with any other real estate licensee. If any agency relationship exists, the undersigned is represented as a __ Seller __ Buyer. J atTN lJ \ reuS - I /(C/.>/~E=-----==-----=:-- _ _ _ Potential D Buyer DC Seller (check one) Potential D Buyer D Seller (check one) Date G\ PP(.)5F~"·-f/L':;1I--tU,>;r-r·L./C: "<b.4L.Esr~TE B~()kF~. Copyright June 2008 by the Southwestern Michigan Association of REALTORS®, Inc. Use of this form by non~members is stlictly prohibited. Produced with zlpForl1"l®by zipLoglx 18070 Fitteen Mile Road. Fraser. Michigan 48026 wwwzjpLoolxcpm Page 2 of2
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