Can this disclosure be signed electronically?

Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signer consents and the record is retained in a reproducible form.

Is notarization required for the disclosure?

Typically no. Buyer agency disclosures are generally executed between buyer and agent and do not require notarization, unless state or brokerage policy specifies otherwise.

What if the buyer withdraws consent?

A buyer can revoke agency per the terms in the disclosure; document revocation in writing and retain both the revocation and original disclosure for the transaction file.

How long must the brokerage retain signed disclosures?

Retention varies; retain executed disclosures for at least three years post-transaction and longer when state law, IRS rules, or HIPAA apply.

Are dual agency disclosures different?

Yes. Dual agency clauses must explain conflicts and obtain informed, written consent from both parties per state rules and brokerage policy.

What authentication level is recommended?

Use email plus SMS or stronger multi-factor authentication for remote signings; increase authentication for high-risk transactions or when required by broker policy.

Electronic Signature
Templates
Real estate
Buyer Agency Disclosure Form

Buyer Agency Disclosure Form

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

BUYER AGENCY DISCLOSURE FORM

Date of Disclosure:

PROPERTY IDENTIFICATION

Property Address Parcel / APN Number Legal Description

PARTIES AND CONTACT INFORMATION

Buyer Full Legal Name Buyer Contact (Address, Phone, Email) Brokerage / Firm Name Agent Name and License Brokerage Contact (Address / Phone)

NATURE OF REPRESENTATION

The broker and named agent are disclosing the available types of agency relationships. The parties confirm the agency relationship as indicated below. Agency duties described below are illustrative of those required by law and by the brokerage's policies.

Agency Relationship Selected:

Buyer Agent — Broker represents the Buyer and owes fiduciary duties to the Buyer. Seller Agent — Broker represents the Seller and owes fiduciary duties to the Seller. Dual Agent — Broker represents both Buyer and Seller with written consent; duties may be limited by law. Designated Agent — Broker designates a specific agent to represent Buyer while other agents represent Seller.

CONSENT TO DUAL AGENCY (IF APPLICABLE)

If dual agency is selected above, the Buyer acknowledges that certain confidential information may not be disclosed to the other party without express written consent. By checking the box below, Buyer consents to dual agency and understands the limited duties applicable to dual agency under law.

Buyer consents to dual agency as described herein. Buyer consents to dual agency with the following limitations or instructions:

DUTIES OF THE AGENT

The agent owes the Buyer duties that include, but are not limited to: reasonable skill and care; promotion of the Buyer's best interests; timely presentation of all written offers and counteroffers; honest and fair dealing; disclosure of material facts known by the agent; and compliance with all applicable laws. Certain duties may be limited in dual agency situations.

BROKER COMPENSATION

Compensation to the brokerage may be paid by the Buyer, the Seller, or both. Payment of compensation does not, by itself, create an agency relationship. Disclosed compensation arrangements are as follows:

Compensation to Brokerage

PROPERTY CONDITION DISCLOSURES

The broker has no duty to inspect the property for physical defects, unless otherwise agreed in writing. The Buyer should obtain any desired inspections. The following matters are to be acknowledged by the Buyer regarding known disclosures.

Lead-Based Paint: Yes No Mold or Moisture Issues: Yes No Prior Material Damage or Repairs (structural/flood/fire): Yes No Additional Known Condition Disclosures:

ACKNOWLEDGMENT AND CERTIFICATION

By signing below, Buyer acknowledges receipt of this Buyer Agency Disclosure Form, confirms that the Buyer has been informed of the possible types of agency relationships, and either authorizes or declines agency arrangements as indicated above. Buyer certifies that the information provided in this form is true and correct to the best of Buyer's knowledge. This Disclosure does not create any contractual obligation beyond the scope expressly agreed in writing elsewhere.

Governing Law: This Disclosure will be construed and enforced in accordance with applicable state law. Entire Agreement: This Disclosure constitutes the entire statement of agency between the parties with respect to the Buyer and supersedes prior oral statements regarding agency.

Buyer:

By:

Date:

Broker/Agent:

By:

Date:

What the Buyer Agency Disclosure Form Is and why it matters

The Buyer Agency Disclosure Form documents the relationship between a prospective buyer and a real estate licensee, describing duties, loyalty, and how the agent will be compensated. It clarifies whether the agent represents the buyer exclusively, represents both buyer and seller (dual agency where permitted), or acts as a transaction broker. The form helps establish consent to the agency arrangement and creates a written record that can be retained electronically under ESIGN and state UETA rules where applicable.

Why a written Buyer Agency Disclosure matters

A clear written disclosure reduces confusion about who the agent represents, documents consent to agency duties and compensation, and creates an auditable record that supports regulatory compliance and dispute resolution.

Who typically completes the Buyer Agency Disclosure Form

The form is completed by the buyer and the buyer's agent at the start of their relationship or at first substantive contact.

Buyers who want written confirmation of agent duties and compensation
Licensed buyer's agents or brokers representing prospective purchasers
Brokerage compliance officers and transaction coordinators maintaining records

Core elements included in a professional Buyer Agency Disclosure Form

A complete form covers identity, agency type, agent duties, compensation, duration, and signatures to create an enforceable record of representation.

Parties

Names and brokerages for the buyer and the licensee, including business address and license numbers where applicable.

Agency Type

A clear statement whether the agent will act as buyer's agent, dual agent (if allowed), or transaction broker and related limitations.

Agent Duties

A concise list of fiduciary duties (loyalty, confidentiality, disclosure, reasonable care) and any exceptions specific to the transaction.

Compensation

How the agent will be paid, who pays (buyer, seller, or third party), and whether compensation affects duties or conflicts.

Duration

Effective date and termination conditions (automatic expiration, closing, revocation) to define the scope of representation.

Signatures

Signature, printed name, and date lines for buyer and agent, plus a space for broker or firm acknowledgement if required.

Required fields commonly found on the form

Buyer Legal Name: Full name as ID

Agent Name: Brokerage and license

Effective Date: MM/DD/YYYY

Agency Type: Buyer/dual/transaction

Compensation Terms: Amount or source

Signatures and Dates: Signed and dated

Step-by-step: completing the Buyer Agency Disclosure Form

Use this sequence to prepare, review, sign, and distribute the executed disclosure efficiently.

01

Prepare the Form: Select correct template and jurisdiction settings.
02

Enter Parties: Enter buyer and agent details precisely.
03

Confirm Terms: Verify agency type, duties, and compensation.
04

Sign and Save: Obtain signatures and store an executed copy.

Where to send or file the executed disclosure

Routing depends on brokerage policy and state rules; keep copies with relevant transaction records and distribute to the buyer and supervising broker.

Buyer Copy: Deliver executed copy to the buyer for their records.
Brokerage File: Retain a signed copy in the brokerage transaction file.
Transaction Coordinator: Provide copy to coordinator for closing workflows.
Lender or Title: Share if requested by lender or title company as part of underwriting or closing.

Digital delivery and eSubmission considerations

Ensure your platform supports secure PDF, audit trails, and the authentication level required by your brokerage or state.

File Formats: PDF, DOCX supported; preserve uneditable copy.
Authentication: Email link, SMS code, or stronger KBA if required.
Integrations: Connect with MLS, CRM, or document storage systems.

Timing and retention actions to watch for

Pay attention to when disclosures must be provided, how long signed copies must be kept, and any event that triggers automatic expiration.

Timing of Disclosure:

Provide at or before first substantive contact in many broker policies.

Effective Date:

The effective date governs duties and termination timing.

Retention Requirement:

Keep executed copy per brokerage retention policy and regulatory standards.

Offer Submissions:

Attach disclosure to offers if required by local practice.

Compensation Reporting:

Document compensation terms if needed for tax reporting.

Common preparation and execution mistakes to avoid

Failing to use the correct state-specific template creates compliance gaps and may render the disclosure ineffective in certain jurisdictions.
Leaving the agency type or compensation fields blank can produce confusion about who the agent represents and lead to disputes.
Using inconsistent party names or abbreviations that don't match ID or brokerage records can delay verification and create audit issues.
Relying on an unsigned or unsigned PDF copy without a verifiable audit trail risks later challenges to consent or execution validity.

Consequences of errors or omission on the disclosure

Regulatory Action: Disciplinary fines or license sanction

Civil Liability: Potential malpractice or fiduciary claims

Contract Risk: Offers or agreements challenged

Withholding Risk: Compensation disputes or withholding

Recordkeeping Risk: Failure to meet retention obligations

Closing Delays: Title or lender objections

Real-world examples of the disclosure in use

These short examples show common scenarios where a signed Buyer Agency Disclosure clarified representation and avoided disputes.

Martin Properties — Tim Martin, Founder

A local brokerage adopted an electronic disclosure to standardize first-contact practices.

The disclosure was presented and signed before showings.
This practice reduced later disputes about representation and accelerated offer submission by creating a clear written record attached to the file.

Fertility Centers of Illinois — John Butler, Founder

An enterprise client integrated disclosures into their transaction workflow for remote closings.

All parties signed digitally with an audit trail.
The result was consistent compliance with brokerage policy and a reliable, searchable archive for audits and client inquiries.

Comparison: eSignature providers for executing Buyer Agency Disclosure Forms

Platform choice affects cost, authentication options, and compliance features such as HIPAA and envelope limits; signNow appears first for direct comparison.

	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 credit card	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 the Buyer Agency Disclosure Form

Answers to common questions about execution, eSigning, and recordkeeping for buyer agency disclosures.

Need help? Contact support

Can this disclosure be signed electronically?
Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signer consents and the record is retained in a reproducible form.
Is notarization required for the disclosure?
Typically no. Buyer agency disclosures are generally executed between buyer and agent and do not require notarization, unless state or brokerage policy specifies otherwise.
What if the buyer withdraws consent?
A buyer can revoke agency per the terms in the disclosure; document revocation in writing and retain both the revocation and original disclosure for the transaction file.
How long must the brokerage retain signed disclosures?
Retention varies; retain executed disclosures for at least three years post-transaction and longer when state law, IRS rules, or HIPAA apply.
Are dual agency disclosures different?
Yes. Dual agency clauses must explain conflicts and obtain informed, written consent from both parties per state rules and brokerage policy.
What authentication level is recommended?
Use email plus SMS or stronger multi-factor authentication for remote signings; increase authentication for high-risk transactions or when required by broker policy.

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