I understand that if I choose to be a customer, I am limiting the services that I can receive. 

(Initial) __________		(Initial) __________
Agency Disclosure Acknowledgement Form 

I have received The Agency Disclosure Brochure and my Agent has thoroughly explained to me the difference between a Broker in Charge (The Company/Agent), and the Associated Licensee /Sub Agent. 	

(Initial) __________		(Initial) __________

I understand that if I choose to be a client, I am required to sign a written agency agreement which clearly states the terms and conditions of establishing a relationship in order to conduct the business of real estate and reveals the services that I am entitled to. 
	
(Initial) __________		(Initial) __________
I have been educated on Single Agency Representation, Dual Agency Representation, and Designated Agency Representation and I understand how each representation affects the transaction. 	

(Initial) __________		(Initial) __________
Printed Name ______________________________________
Date _________
Signature _________________________________________
Printed Name ______________________________________
:    Date ________ 
Signature _________________________________________