Can the form be e-signed?

Yes. Under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, most Broker Disclosure Forms can be signed electronically if the parties demonstrate intent, consent, attribution, and retention capability.

When is notarization required?

Notarization depends on state law and the document's role; many broker disclosures do not require notarial acknowledgment, but deeds or powers of attorney attached to a transaction may require notarization or witnesses under state statutes.

What if a field contains an error?

Correct material errors by executing an amendment or a corrected disclosure signed by all parties. Keep an audit trail showing the reason and date of the amendment to avoid later disputes.

Who must sign the form?

The broker (or designated agent) and the client or authorized representative should sign. If a third party signs, attach evidence of signatory authority, such as a power of attorney.

How long must I keep the form?

Retain disclosures per applicable rules: IRS guidance generally three years (IRC §6501(a)), broker-dealer rules may require six years (17 CFR §240.17a-4), and HIPAA-covered items six years (45 CFR §164.530(j)).

How to revoke or amend a disclosure?

Revoke or amend by executing a written, dated amendment acknowledged by all parties. Document the reason and retain both the original and amended versions for audit and dispute resolution.

Electronic Signature
Templates
Finance
Broker Disclosure Form

Broker Disclosure Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BROKER DISCLOSURE FORM

This Broker Disclosure Form is provided to disclose the broker's identity, agency relationship, compensation arrangements, material interests, and any potential conflicts of interest relating to the transaction described below. The broker certifies that the information set forth herein is true and complete to the best of the broker's knowledge and that the broker will comply with applicable fiduciary duties and statutory obligations.

Transaction Details

Transaction Type: Sale Purchase Lease Other

Property / Asset Description:

Date of Disclosure:

Broker Information

Brokering Firm / Company Designated Broker / Agent License Number / Identifier Broker Address

Phone

Email

Client Information

Client Name

Client Type: Individual Entity

Client Contact

Phone

Email

Agency Relationship and Duties

The broker's relationship to the client in the above transaction is as follows (select applicable):

Seller's Agent — broker represents the seller and owes fiduciary duties to the seller.

Buyer's Agent — broker represents the buyer and owes fiduciary duties to the buyer.

Dual Agent / Transaction Broker — broker may act for both parties; such arrangement may limit the broker's ability to fully advocate for either party and requires informed consent.

If dual agency or limited representation is selected, client acknowledges and expressly consents: Client consents to dual agency and limited disclosure as described above.

Compensation, Fees and Referral Arrangements

Compensation payable to broker: Commission, fee, or other compensation will be paid as follows.

Commission / Fee Structure Estimated Commission / Fee Amount

The broker may receive compensation from other parties or split compensation with cooperating brokers. Yes No

Describe any referral fees, third-party compensation, or splits

Material Interests and Conflicts of Interest

The broker must disclose any material interests, prior relationships, or financial benefits that could reasonably affect the broker's objectivity.

Disclosed Material Interests or Conflicts

Confidentiality and Use of Client Information

Unless otherwise agreed in writing, the broker will treat client information as confidential, subject to legal exceptions and duties to disclose material facts to other parties where required by law. Client acknowledges that certain information may be shared with cooperating brokers, lenders, title companies, and others necessary to complete the transaction.

Client acknowledges receipt of this disclosure and the broker's confidentiality statement: Acknowledged

Broker Certification

The undersigned broker certifies, under penalty of perjury, that the information provided on this form is true and correct to the best of the broker's knowledge, that all material relationships and compensation arrangements have been disclosed, and that the broker will perform duties in accordance with applicable law and professional standards.

Client Acknowledgment

By signing below, the client acknowledges receipt of this Broker Disclosure Form prior to entering into any agency agreement or contract related to the transaction described above, and acknowledges understanding of the disclosures made herein.

Client acknowledges receipt: Yes

Broker Printed Name:

By:

Date:

Client Printed Name:

By:

Date:

What the Broker Disclosure Form Is and when it's used

The Broker Disclosure Form documents a broker's relationship, compensation, and duties when representing parties in a transaction. It typically identifies the broker, license details, the client or customer, the scope of services, and any compensation or referral arrangements. The form creates transparency about who the broker represents and how they are paid, and is commonly used in real estate, financial intermediation, and business brokerage contexts to avoid conflicts of interest and satisfy state licensing or disclosure rules.

Why the Broker Disclosure Form matters for compliance and clarity

A clear Broker Disclosure Form protects all parties by documenting agency, compensation, and potential conflicts of interest. Well-prepared disclosures reduce regulatory risk, support enforceability of agreements, and create a record that parties relied on when consenting to representation or payment terms.

Who completes and relies on the Broker Disclosure Form

Typical users include licensed brokers, their employing firms, clients, and closing agents who need a record of agency and compensation.

Licensed brokers and brokerages who must disclose agency and fees to clients and customers.
Buyers, sellers, or principals who need written confirmation of broker duties and payment arrangements.
Title companies, escrow agents, and compliance officers who verify disclosed relationships before closing.

Maintain copies with transaction files and with any supervising broker or compliance department for the required retention period.

Primary signers and responsible parties

Broker — Licensee

A licensed broker or designated agent must complete broker identity fields, provide license number, and acknowledge duties. The broker's firm or supervising broker may also need to sign and accept responsibility for disclosures and compliance with state real estate law.

Client — Principal

The buyer or seller (or their authorized representative) signs to acknowledge receipt and understanding of the broker's disclosures, confirm agency selection, and consent to compensation arrangements specified on the form.

Required data elements on the form

Broker name: Full legal name

License number: State license ID

Client name: Full legal name

Property/transaction: Address or transaction ID

Compensation: Amount or formula

Date: MM/DD/YYYY

Consequences of defective or missing disclosures

Regulatory sanction: License discipline

Civil liability: Damages or rescission

Contract risk: Voidable agreement

Tax exposure: Incorrect reporting (IRC §6721)

Closing delays: Funds or title held

Reputational harm: Client complaints

Common mistakes to avoid when preparing the form

Leaving the broker license number blank or entering an expired license, which can trigger state regulatory questions and delay approvals.
Using vague compensation language such as 'market rate' without a formula or dollar figure, creating disputes over what the broker is owed.
Failing to have the client sign and date the form, which undermines proof of disclosure and may invalidate assertions of informed consent.
Not matching the client name to government ID or closing documents, causing identity checks or escrow processing problems.

Step-by-step: Completing a Broker Disclosure Form

Follow these steps to prepare, verify, and finalize the disclosure for a typical transaction.

01

Prepare: Enter broker, firm, and client details accurately.
02

Describe agency: State if broker represents buyer, seller, or both.
03

Detail compensation: Specify amount or commission formula.
04

Sign and date: Have broker and client sign; record date.

Where to file, send, and keep the completed form

After execution, route copies to the parties and retain originals per corporate or state retention schedules.

Client copy: Provide client-signed PDF or paper copy.
Brokerage file: Store original in brokerage transaction folder.
Closing agent: Share with title/escrow for closing.
Regulator: Produce on audit or compliance request.

How to set up a digital workflow for disclosures

Configure a workflow that captures signatures, timestamps, and an audit trail for each Broker Disclosure Form.

Field	Configuration
Signature	Required signer field, date capture
Identity check	Email + SMS code or KBA as needed
Document versioning	Lock after final signature
Audit record	Capture IP, timestamp, and actions

Technical considerations for eSigning and eSubmission

Choose a platform that supports audit trails, acceptable signer authentication, and secure storage for transaction records.

File formats: PDF, DOCX supported
Integrations: CRM, Title, and Cloud storage
Security: TLS and AES encryption

Ensure the chosen provider supports ESIGN/UETA compliance, optional HIPAA BAA if health data is present, and integrations with systems such as Salesforce, NetSuite, or Google Workspace.

Timing and deadlines to watch for with disclosures

Key timing depends on state law and transaction milestones; start disclosures early to avoid last-minute issues.

Provide disclosure:

At first substantive contact or per state rule

Client acknowledgement:

Prior to contract execution when required

Amendments:

Update immediately when material facts change

Retention start:

Date of final signed disclosure

Produce on audit:

Within regulator-requested timeframe

Key processing milestones for a Broker Disclosure Form

Typical milestone sequence from preparation through storage for a completed disclosure.

01

Draft and review

Prepare disclosure and verify license information.

02

Deliver to client

Provide form and explain agency/compensation terms.

03

Obtain signatures

Secure broker and client signatures with dates.

04

Practical examples of Broker Disclosure Form use

Real-world examples show how disclosures are used to document agency, speed closing, and reduce disputes.

Martin Properties — Residential Sales

Local brokerage adopted an online disclosure to streamline listings and client intake.

The tool captured signatures remotely.
"I can process and execute all of these documents online with 100% compliance and built-in security," said Tim Martin, Founder, describing faster turnarounds and fewer in-person meetings.

Optica Ventures — Commercial Brokerage

A commercial team standardized disclosures in their CRM to ensure compliance across agents.

The form included commission formulas and referral clauses.
Brian Fitzgibbons, COO, noted that a consistent disclosure reduced internal audit time and improved clarity for clients during negotiations.

eSignature vendor comparison for Broker Disclosure Form workflows

Comparing vendor starting prices and core capabilities can help select a provider that supports disclosures, audit trails, and optional HIPAA compliance.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	No	No	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about Broker Disclosure Forms

Answers to common legal, technical, and procedural questions about preparing, signing, and storing Broker Disclosure Forms.

Need help? Contact support

Can the form be e-signed?
Yes. Under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, most Broker Disclosure Forms can be signed electronically if the parties demonstrate intent, consent, attribution, and retention capability.
When is notarization required?
Notarization depends on state law and the document's role; many broker disclosures do not require notarial acknowledgment, but deeds or powers of attorney attached to a transaction may require notarization or witnesses under state statutes.
What if a field contains an error?
Correct material errors by executing an amendment or a corrected disclosure signed by all parties. Keep an audit trail showing the reason and date of the amendment to avoid later disputes.
Who must sign the form?
The broker (or designated agent) and the client or authorized representative should sign. If a third party signs, attach evidence of signatory authority, such as a power of attorney.
How long must I keep the form?
Retain disclosures per applicable rules: IRS guidance generally three years (IRC §6501(a)), broker-dealer rules may require six years (17 CFR §240.17a-4), and HIPAA-covered items six years (45 CFR §164.530(j)).
How to revoke or amend a disclosure?
Revoke or amend by executing a written, dated amendment acknowledged by all parties. Document the reason and retain both the original and amended versions for audit and dispute resolution.

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