Can this questionnaire be signed electronically?

Yes. Electronic signatures meeting the ESIGN Act and state UETA requirements are valid for most business agreements; ensure the signatory demonstrates intent, consents to e-signing, attribution is clear, and records are retained per 15 U.S.C. §7001 and applicable state law.

Do responses require notarization or witnesses?

Generally no for a selection questionnaire, but specific attestations or executed contracts may require notarization or witnesses in some jurisdictions. If notarization is needed, follow state RON or in-person notarization rules.

Who is authorized to sign the completed questionnaire?

An authorized corporate officer or appointed signer must sign. Name the authorized signer in the Authorized Signer field and ensure their title appears on corporate records to avoid challenges to authority.

How do I correct or update submitted answers?

If changes are needed, submit an amended questionnaire clearly labeled as an update and routed through the same review and approval path. Retain both versions for audit purposes.

What if a broker provides incomplete or inconsistent information?

Request clarifications within the specified clarification window. Document any missing items and withhold scoring or contract award until mandatory compliance items are verified.

Are there data privacy or HIPAA concerns when collecting information?

If the questionnaire collects protected health information or other regulated data, apply HIPAA safeguards and a BAA where required. Limit collection to minimum necessary information and follow 45 CFR §164.530(j) for retention.

Electronic Signature
Templates
Miscellaneous
Broker Selection Questionnaire

Broker Selection Questionnaire

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

BROKER SELECTION QUESTIONNAIRE

WHEREAS, Client Name: (the entity seeking broker services) desires to evaluate and potentially engage Broker Firm: to provide transactional and advisory services; and

WHEREAS, the parties intend to document Broker's qualifications, fees, conflicts, and proposed scope of work prior to the execution of any binding engagement; and

WHEREAS, Broker represents that the information provided in this Questionnaire is true and correct to the best of Broker's knowledge and that Broker will promptly disclose any material changes to such information.

Broker Information

Firm Legal Name DBA / Trade Name (if any) Entity Type (select all that apply)

Corporation LLC Partnership Sole Proprietor Other:

Primary Contact Contact Email Contact Phone Office Address

Licensing, Qualifications, and Experience

Relevant License Numbers and Jurisdictions Professional Designations and Certifications Years in Business

Scope of Work

Describe in detail the services Broker proposes to provide, including deliverables, milestones, and any limitations on authority. If an engagement agreement is later executed, the definitive Scope of Work will be incorporated therein.

Fee Proposal and Payment Terms

Proposed Compensation Structure

Commission / Fee Rate: Minimum Fee (if any):

Payment Schedule and Invoicing

Late Payment Fee (if any):

Term and Termination

Proposed Engagement Start Date: Proposed Engagement End Date (if applicable):

Termination Notice Period: Termination for Cause: Broker must state grounds that would permit immediate termination:

Confidentiality

Broker acknowledges that during the course of discussions and any subsequent engagement it may receive Confidential Information from Client. Broker agrees to: (a) hold all Confidential Information in strict confidence; (b) use such information solely for the purpose of performing services for Client; and (c) not disclose Confidential Information to any third party without Client's prior written consent, except as required by law. Confidential Information does not include information that (i) is or becomes publicly available through no breach of this obligation; (ii) was rightfully known to Broker prior to disclosure; or (iii) is independently developed without reference to Client’s Confidential Information.

Conflicts, Disclosures and References

Does Broker have any actual or potential conflicts of interest with Client or the proposed transaction?

No known conflicts Yes — see explanation below

If yes, describe all conflicts and proposed mitigations Client References (minimum two)

Insurance and Compliance

Errors & Omissions (E&O) Insurer: Policy Number:

Coverage Limits: Policy Expiration Date:

Attachments

Attach any supporting documentation (firm brochure, sample engagement letter, insurance declarations, representative transaction summaries). List attachments below.

Representations and Certification

By signing below, Broker certifies that the information contained herein is true and complete, that Broker is not aware of any unresolved disciplinary actions materially affecting Broker's ability to perform the proposed services, and that Broker will promptly notify Client of any material change in such information prior to or during any engagement.

I certify that the information provided is true and correct under penalty of perjury.

Governing Law and Entire Agreement

Governing Law: The interpretation and enforcement of this Questionnaire and any subsequent engagement letter shall be governed by the laws of the State of without regard to conflict of law principles.

Entire Agreement: This Questionnaire constitutes the full statement of Broker's qualifications and preliminary fee proposal. Any binding engagement of Broker by Client shall be effectuated only by a separate written engagement agreement executed by the parties; except as otherwise set forth in such engagement agreement, the terms of that agreement shall prevail. This Questionnaire does not create an obligation on the part of Client to retain Broker.

Client Name:

By:

Date:

Broker Firm:

By:

Date:

What the Broker Selection Questionnaire Is and when it's used

A Broker Selection Questionnaire is a standardized form used by organizations to evaluate and compare prospective brokers across compliance, capability, pricing, and service criteria. It captures licensing details, disclosures, fee schedules, references, service level expectations, insurance and conflict-of-interest information, and required attestations. Organizations use the questionnaire during vendor procurement, due diligence, or renewal cycles to document objective scoring and to create an audit record that supports award decisions and regulatory reviews.

Why a formal questionnaire matters for broker procurement

A structured Broker Selection Questionnaire reduces ambiguity, supports fair vendor comparisons, and creates a documented audit trail for procurement and compliance teams. It helps manage regulatory risk by collecting license and insurance proof, enables consistent fee benchmarking, and improves transparency during negotiation and contracting.

Teams and roles that typically complete or request this questionnaire

Typical users include procurement, compliance, and business-unit owners who need to evaluate broker capabilities and risks before contracting.

Procurement managers responsible for vendor selection, scoring, and maintaining procurement records.
Compliance or legal teams verifying licensing, insurance, conflict disclosures, and statutory requirements.
Business-unit leaders who compare service models, fees, and performance references to meet operational needs.

Core sections to include in a professional Broker Selection Questionnaire

A complete questionnaire groups related items to streamline review and scoring. Organize sections so reviewers can quickly verify mandatory compliance items first, then evaluate service, fees, and references.

Broker Profile

Legal business name, DBA, EIN, offices, and primary contact details for identification and verification.

Licensing & Regulation

State license numbers, issuing authority, active status, and any disciplinary history or regulatory actions.

Fees & Compensation

Detailed fee schedules, commission structures, expense pass-throughs, and examples of total cost of engagement.

Service Levels

Scope of services, turnaround times, escalation paths, and any guaranteed service-level metrics or reporting cadence.

References & Performance

Client references, case studies, performance KPIs, and sample reporting provided for validation of claims.

Insurance & Conflicts

Proof of insurance, limits, indemnity language, and disclosures of potential conflicts of interest or related-party relationships.

Step-by-step process to complete and review the questionnaire

Follow these steps in sequence to gather information, complete the form, validate entries, and route for approval.

01

Gather documents: Collect licenses, COIs, sample invoices and references before starting.
02

Complete sections: Fill each field precisely, using MM/DD/YYYY for dates and full legal names.
03

Validate data: Cross-check license status and insurance certificates against issuing registries.
04

Route for approval: Send completed questionnaire to procurement and compliance for scoring and signature.

Configuring an online questionnaire workflow

Design routing and authentication to match your procurement policy and risk tolerance when using an online form.

Field	Configuration
Authentication method	Email verification with optional SMS code for higher assurance
Routing order	Sequential: broker → procurement reviewer → legal approver
Conditional fields	Show insurance fields only if coverage checkbox selected
Integration	Map responses to CRM or procurement system (for example, Salesforce)

Digital distribution and technical file requirements

Decide on file formats, integrations, and signer authentication before issuing the questionnaire.

File formats: PDF, DOCX supported for templates
Integrations: CRM and storage: Salesforce, Google Workspace, Box
Authentication: Email, SMS, or knowledge-based verification

Where to send completed questionnaires and how routing works

Determine final storage and review points so each completed questionnaire follows a consistent record path and is discoverable for audits.

Procurement repository: Upload final PDF to central procurement folder for retention
Contract folder: Attach questionnaire to the contract record in the contract management system
Compliance review: Route copies to compliance for license and insurance checks
Internal audit: Provide access for internal audit and future vendor performance reviews

Typical timelines and deadlines for issuing and receiving responses

Set clear, measurable deadlines in the questionnaire notice to ensure timely comparisons and award decisions.

Response deadline:

Commonly 7–21 calendar days from issuance depending on complexity

Clarification period:

Allow 3–5 business days for follow-up questions

Evaluation window:

Procurement review typically completes within 5–10 business days

Award notification:

Notify shortlisted brokers within 7 business days after scoring

Contract start:

Target start date should be specified in the solicitation

Key milestones from issuance to contract start

A milestone timeline clarifies expectations and creates checkpoints for both the issuing team and responding brokers.

01

Issue Questionnaire

Publish questionnaire and set response deadline for brokers

02

Receive Responses

Collect completed questionnaires and supporting attachments

03

Compliance Review

Verify licenses, insurance, and disclosures

04

Scoring & Award

Score responses, select finalist, and proceed to contracting

Common mistakes to avoid when preparing or issuing the questionnaire

Unclear or inconsistent questions that produce non-comparable answers and require manual follow-up, delaying decision timelines.
Accepting unsigned attachments or incomplete insurance certificates, which creates compliance gaps during vendor onboarding.
Failing to specify required formats and formats for dates or license numbers, causing parsing and verification errors.
Not setting or enforcing a response deadline, leading to ad hoc submissions and missed procurement schedules.

Risks and potential consequences of incorrect or incomplete questionnaires

Procurement Delay: Project start delays

Contract Invalidity: Unenforceable terms

Regulatory Noncompliance: Licensing or insurance violations

Financial Loss: Penalty or remediation costs

Tax Withholding: Backup withholding risk

Reputational Harm: Stakeholder distrust

Comparison of typical eSignature vendor pricing and feature criteria

Pricing and feature availability differ by vendor and plan. Use this table to compare starting price, trial availability, bulk send, audit trail, HIPAA support, and envelope limits.

	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 card	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently asked questions about using the Broker Selection Questionnaire

Answers to common questions about e-signatures, notarization, authority to sign, and correcting submitted responses.

Need help? Contact support

Can this questionnaire be signed electronically?
Yes. Electronic signatures meeting the ESIGN Act and state UETA requirements are valid for most business agreements; ensure the signatory demonstrates intent, consents to e-signing, attribution is clear, and records are retained per 15 U.S.C. §7001 and applicable state law.
Do responses require notarization or witnesses?
Generally no for a selection questionnaire, but specific attestations or executed contracts may require notarization or witnesses in some jurisdictions. If notarization is needed, follow state RON or in-person notarization rules.
Who is authorized to sign the completed questionnaire?
An authorized corporate officer or appointed signer must sign. Name the authorized signer in the Authorized Signer field and ensure their title appears on corporate records to avoid challenges to authority.
How do I correct or update submitted answers?
If changes are needed, submit an amended questionnaire clearly labeled as an update and routed through the same review and approval path. Retain both versions for audit purposes.
What if a broker provides incomplete or inconsistent information?
Request clarifications within the specified clarification window. Document any missing items and withhold scoring or contract award until mandatory compliance items are verified.
Are there data privacy or HIPAA concerns when collecting information?
If the questionnaire collects protected health information or other regulated data, apply HIPAA safeguards and a BAA where required. Limit collection to minimum necessary information and follow 45 CFR §164.530(j) for retention.

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