Broker Representation Consent Form

BROKER REPRESENTATION CONSENT FORM

This Broker Representation Consent Form (the Agreement) is made effective as of by and between Client Name: with address ("Client"), and Broker Name: License No. of Brokerage Firm: with principal office at ("Broker").

RECITALS

WHEREAS, Client is seeking representation in connection with the purchase, sale, lease or other disposition of real property and desires to engage Broker to provide brokerage services in accordance with the terms and conditions set forth herein.

WHEREAS, Broker holds a valid and active license to provide real estate brokerage services and represents that Broker has the experience and capacity to perform the services described in this Agreement.

WHEREAS, the parties acknowledge that Broker may be asked to represent multiple parties in a transaction and that certain disclosures and consents are required under applicable law and professional obligations.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. APPOINTMENT AND SCOPE

Client hereby retains Broker to act as Client's exclusive/non-exclusive (selectable by mutual written consent) agent for the following matters: description of the property or transaction:

Broker shall provide customary brokerage services including, as applicable, advising on pricing and market conditions, identifying prospective buyers/sellers/lessors/lessees, negotiating terms, preparing and presenting offers and counteroffers, coordinating inspections and closings, and such other services as the parties may agree in writing.

2. BROKER DUTIES AND STANDARD OF CARE

Broker will act with reasonable skill, care and diligence and will comply with applicable statutes, licensing rules, and professional obligations. Broker shall disclose to Client all material facts known to Broker that might affect Client's decisions regarding the transaction and shall present all offers and counteroffers in a timely manner.

3. CLIENT DUTIES

Client agrees to deal honestly and to provide Broker with accurate information relevant to the transaction. Client will not knowingly provide false information and will promptly notify Broker of any material changes affecting the transaction. Client authorizes Broker to communicate and disclose Client's relevant facts to third parties as necessary to effectuate the transaction.

4. DUAL OR MULTIPLE REPRESENTATION

Broker may represent other clients whose interests may be adverse to Client's interests in the same transaction. Client acknowledges receipt of this disclosure and provides the following election (select one):

Client gives informed consent to Broker representing more than one party in a transaction, provided Broker discloses material information to all principals as required by law and obtains necessary consents.

Client does not consent to Broker representing more than one party in the same transaction. If dual representation becomes necessary, Broker will withdraw or obtain a subsequent written consent from Client.

If Client consents to multiple representation, Client authorizes Broker to disclose to other parties and their agents those facts that Broker reasonably believes are material to the transaction and not expressly confidential by written instruction of Client. List any parties for which Client expressly consents representation:

5. COMPENSATION

Client agrees to compensate Broker as follows. Commission or fee payable: or Fixed Fee:

Unless otherwise agreed in writing, commission or fee becomes earned and payable at closing or upon performance of the act that entitles Broker to compensation. Payment may be made by Client or another mutually agreed source. If the transaction fails due solely to Client's material breach, Client shall remain responsible for any earned or agreed fees.

6. TERM AND TERMINATION

This Agreement commences on the effective date set forth above and will continue until unless earlier terminated in writing by either party. Either party may terminate this Agreement upon written notice to the other; however termination shall not relieve Client of obligations to pay for services already rendered or commissions earned prior to termination.

Notice period for termination: days.

7. CONFIDENTIALITY

Broker shall maintain in confidence non-public information obtained from Client, except as authorized by Client or required by law, and shall not disclose Client's confidential information to third parties without Client's prior written consent. Confidential information does not include information that is or becomes public through no breach of this Agreement or that Broker obtained independently prior to disclosure.

8. CONFLICTS OF INTEREST

Broker will disclose to Client any actual or potential conflicts of interest of which Broker becomes aware. Where a material conflict exists that cannot be resolved to the satisfaction of Client, Broker will withdraw or take other action as required by law and professional duty.

9. NOTICES

10. AMENDMENTS; WAIVER

This Agreement may be amended only by a written instrument executed by both parties. No failure or delay by either party in exercising any right under this Agreement shall operate as a waiver of that right, nor shall any single or partial exercise of any right preclude any other or further exercise of that right.

11. GOVERNING LAW; VENUE

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to choice-of-law principles. The parties submit to the exclusive jurisdiction of the courts located within that State for resolution of any disputes arising under this Agreement.

12. ENTIRE AGREEMENT; SEVERABILITY; COUNTERPARTS

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings and representations. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall continue in full force and effect. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

SIGNATURES

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