Agency Disclosure Form (Template)

AGENCY DISCLOSURE

This disclosure is being provided to you because state law requires that you be informed of the agency relationships available in a business sale transaction. Read this document carefully before proceeding.

1. What Is an Agency Relationship?

An agency relationship is created when one person (the "agent") is authorized to act on behalf of another (the "principal"). A broker acting as an agent owes the principal fiduciary duties, which may include loyalty, confidentiality, disclosure, obedience, and reasonable care, to the extent required by the law of the state where the transaction occurs.

2. Types of Agency Relationships Available

Seller's Agent (Listing Broker). Represents the seller and owes the seller fiduciary duties. The seller's agent must treat the buyer honestly but is not the buyer's agent.

Buyer's Agent (Buyer Representation). Represents the buyer and owes the buyer fiduciary duties, including loyalty and confidentiality.

Transaction Broker / Facilitator. Represents neither party as an agent. A transaction broker facilitates the transaction and deals with both parties on the same level of trust but owes no fiduciary duties, only honesty, fairness, and disclosure of material facts required by law.

Dual Agency. Occurs when the same brokerage represents both the buyer and the seller. Dual agency requires the informed written consent of both parties, and the broker may not act adversely to either party.

3. Disclosure of Agency Relationship

The undersigned parties acknowledge and agree that the broker named below is acting in the following capacity in this transaction (check one):

☐ As the Seller's Agent, representing the Seller exclusively

☐ As the Buyer's Agent, representing the Buyer exclusively

☐ As a Transaction Broker / Facilitator, representing neither party

☐ As a Dual Agent, representing both Seller and Buyer with the written consent of both parties

4. Acknowledgment

I/We acknowledge that:

• 4.1. I/we have read and understand the types of agency relationships described above;
• 4.2. I/we understand the capacity in which the broker is acting, as indicated above;
• 4.3. I/we understand that the broker's role does not include providing legal, tax, or investment advice, and that we have been encouraged to seek independent professional counsel;
• 4.4. I/we consent to the agency relationship disclosed above;
• 4.5. This disclosure does not create a contractual obligation to buy or sell any business.

5. Signatures

SELLER: ______________________________ Date: ____________

BUYER: ______________________________ Date: ____________

BROKER: ______________________________ Date: ____________

Broker license number: ____________________________________

State(s) of licensure: ____________________________________