Is this form legally binding?

Yes. An electronically signed disclosure is generally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and retention requirements are met. Exceptions such as wills and court filings may still require wet signatures.

Do I need a notary or witnesses?

Usually no; most states do not require notarization for agency disclosure forms. Specific jurisdictions or transaction types may require witnesses or notarization, so verify state rules. For documents that do require notarization, use remote online notarization or in-person notarization consistent with state law.

When must the disclosure be provided?

Provide the disclosure at first substantive contact or before entering into a brokerage agreement as required by some states. Deliver a signed copy to each party and retain one in the brokerage file to satisfy regulatory audits and dispute inquiries.

Can disclosures be signed electronically?

Yes. Electronic signatures on disclosures are permitted under ESIGN (15 U.S.C. ch. 96) and UETA when the signatory demonstrates intent, provides consent to electronic records, attribution is clear, and the platform preserves an accurate record of the signed form.

What if names or license numbers are wrong?

Correct any mismatches immediately. Inaccurate names or license numbers can affect tax reporting, title work, and regulatory compliance. Amendments should be initialed and dated by parties; consult counsel for material errors before closing.

How long should I keep the signed disclosure?

Keep disclosures in the brokerage file for the transaction term plus at least three years to meet federal IRS recordkeeping minimums (IRC §6501(a)); retain longer if state law or industry rules require extended periods.

Electronic Signature
Templates
Real estate
Real Estate Agency Disclosure Form

Real Estate Agency Disclosure Form

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REAL ESTATE AGENCY DISCLOSURE FORM

This Agency Disclosure Form explains the nature of the agency relationship between the parties and the brokerage with respect to the property transaction described below. The undersigned acknowledge receipt of the disclosures and state that the information provided below is true and correct to the best of their knowledge.

Property Identification

Property Address Parcel / APN Number Legal Description

Parties and Licensee Identification

Client Name:

Client Contact Address Brokerage Name Brokerage Address Designated Agent / Licensee Name

Agent License Number

Broker License Number

Agent Phone

Agent Email

Agency Relationship (Select All That Apply)

The brokerage and licensees identified above disclose the following agency relationship(s) applicable to this transaction:

Agency Status Single Agent — Broker/Licensee represents the buyer as a fiduciary. Single Agent — Broker/Licensee represents the seller as a fiduciary. Dual Agency — Broker/Licensee may represent both buyer and seller in the same transaction (consent required). Designated Agency — Brokerage designates separate licensees to represent different parties within the same brokerage. Transaction Broker / Non‑Agency — Brokerage provides limited services to facilitate the transaction without fiduciary representation. No Agency — Brokerage has not entered into an agency relationship and acts only as a facilitator of information and communication.

If Dual Agency is selected, the brokerage must obtain the informed, written consent of all affected clients. By selecting the checkbox below, the client acknowledges awareness and gives consent to Dual Agency as described herein.

Client Consent to Dual Agency Client gives informed consent to Dual Agency for this transaction, recognizing potential limitations on fiduciary duties.

Duties, Confidentiality and Conflicts

Duties to clients include loyalty, confidentiality, full disclosure of material facts, obedience to lawful instructions, reasonable care and diligence, and accounting for funds. Duties to customers (non‑clients) include honesty and the disclosure of material facts. Confidential information received during representation will not be disclosed without written authorization except as required by law or as necessary to fulfill duties to the client.

Known or Potential Conflicts of Interest There is a known or potential conflict of interest. Permitted Exceptions to Confidentiality

Compensation / Commission

The following describes who will compensate the brokerage and the general terms of compensation. Compensation may be paid by the seller, buyer, or another party as agreed in a separate contract. The manner of compensation does not by itself create an agency relationship.

Compensation Payable By Compensation Details

Additional Terms and Certifications

By signing below, the client acknowledges receipt of this Agency Disclosure Form, affirms that the client understands the agency options and duties described herein, and certifies that the client has had the opportunity to ask questions and receive answers regarding the nature of representation and compensation.

Additional Agreements or Instructions

The parties acknowledge that this disclosure does not constitute a purchase agreement, listing agreement, or other contract for brokerage services unless those agreements are separately executed in writing.

Client Printed Name:

By:

Date:

Brokerage Representative Printed Name:

By:

Date:

What the Real Estate Agency Disclosure Form Is

The Real Estate Agency Disclosure Form is a standardized document used in property transactions to disclose agency relationships, material facts, and conflicts of interest between brokers, agents, buyers, and sellers. It clarifies who represents each party, whether the agent acts as a seller’s agent, buyer’s agent, dual agent, or limited agent, and lists any material interests the agency may have in the transaction. The form supports informed consent, reduces dispute risk, and is commonly required by state real estate commissions and professional codes of conduct.

Why the Real Estate Agency Disclosure Form Is Important

The Real Estate Agency Disclosure Form establishes transparent agency roles and material disclosures that protect clients and agents. It documents consent and reduces liability by clearly identifying representation and conflicts, aligning with state real estate regulations and professional duty-of-care standards.

Who Typically Completes the Real Estate Agency Disclosure Form

Use this form to document agency relationships for every residential or commercial real estate transaction involving licensed brokers or their agents.

Listing brokers and their affiliated sales agents in seller-side transactions.
Buyer’s agents and brokers when representing purchaser interests in offers.
Clients, consumers, and third parties who must receive agency disclosure copies.

Provide copies to all parties; retain a signed record per state rules and brokerage policy.

Core Sections Every Real Estate Agency Disclosure Form Should Include

A professional form combines clear agency designations, material disclosures, conflict statements, signatures, dates, and contact details to create an enforceable record for the transaction.

Agency Type

Specify whether the relationship is seller’s agent, buyer’s agent, dual agent, or transaction broker; include any limited agency roles and clear definitions of duties and obligations to each represented party.

Material Facts

List known material facts about the property, such as structural defects, environmental hazards, zoning restrictions, or other conditions that may affect valuation or habitability; be specific and dated.

Conflict Disclosure

Disclose any financial interests, referral fees, related-party relationships, ownership interests, or other arrangements the brokerage or agent holds that could influence negotiations, advice, or disclosure obligations in the transaction.

Signatures & Dates

Provide signature blocks for all parties and agents with printed names, dates, and contact details; indicate whether initials are required on each page and where witnesses or notary will sign.

Broker Info

Include brokerage name, license numbers for firm and agents, office address, primary contact phone and email, and broker supervisor information required by state real estate commissions.

Consent & Acknowledgment

Add a consumer consent clause confirming the party received the disclosure, understands the agency role, and consents to the representation as described; include withdrawal procedures if applicable.

Required Information and Fields at a Glance

Full Legal Name: Enter full legal name as on government ID.

Agency Type: Seller, Buyer, Dual, or Limited.

Property Address: Street, city, state, ZIP.

License Numbers: Broker and agent license IDs.

Signature and Date: Sign and date MM/DD/YYYY.

Contact Information: Phone number and email address.

Step-by-Step: Completing the Real Estate Agency Disclosure Form

Complete the form early in marketing or negotiation to document representation and provide each party with a signed copy before substantive discussions.

01

Gather Information: Collect names, addresses, license numbers.
02

Select Agency: Choose buyer, seller, dual, or limited.
03

Disclose Conflicts: List any material interests or referrals.
04

Sign & Distribute: All parties sign; provide retained copies.

Configuring an Online Disclosure Workflow

Set up an e-form template to prefill agent data, place signature fields, route reviewers, and retain an audit trail for compliance and recordkeeping.

Field	Configuration
Prefill Agent Data	Auto-fill license and broker details.
Signature Placement	Place signature, initials, and date fields.
Routing Order	Define signing order for agents and clients.
Retention Settings	Enable audit trail and document storage.

Where to File, Send, or Submit the Completed Disclosure

Provide signed copies to all parties, retain one in the brokerage file, and submit to state agency if required by commission rules.

Seller/Buyer: Give each party an original or copy.
Brokerage File: Keep original disclosure in transaction file.
State Commission: Submit only if state rule mandates.
Closing Agent: Provide copy to title or escrow officer.

Digital Signing and eSubmission Considerations

Use compliant eSignature tools that capture intent, identity, and an audit trail to maintain enforceability under ESIGN and state laws.

Authentication: Email, SMS, or KBA methods.
Audit Trail: Timestamps, IP, and action log.
File Formats: PDF, DOCX, or image accepted.

Timelines, Deadlines, and Processing Expectations

Deliver the disclosure before substantive negotiations or representation begins; some states require disclosure at first substantive contact or prior to certain contract execution.

Timing for Initial Delivery to Parties:

Provide at first substantive contact or before signing.

Requirement Before Contract Execution and Signing:

Deliver prior to mutual acceptance where required.

Record Retention After Closing in Brokerage File:

Keep signed copy in file per state law.

Notarization and Witness Timing Requirements:

Follow state rules for witness or notary timing.

Consequences of Failing to Deliver Disclosure:

May result in rescission rights or administrative penalties.

Common Mistakes When Preparing the Real Estate Agency Disclosure Form

Leaving agency role blank or selecting an incorrect role, which creates ambiguity and increases risk of disputes or regulatory scrutiny during closing and post-closing reviews.
Failing to disclose related-party interests, referral fees, or ownership stakes, which can lead to contract rescission or disciplinary action by state commissions.
Using informal initials or unsigned pages; partial signatures and undated acknowledgments can render the form legally ineffective in contested cases.
Sending the form late — after significant negotiations — that may undermine informed consent and expose agents to liability claims.

Penalties and Risks of an Incorrect Real Estate Agency Disclosure Form

Regulatory Fines: State commission penalties apply.

Contract Rescission: Buyer or seller may rescind.

License Discipline: Suspension or revocation possible.

Civil Liability: Damages for negligence or fraud.

Closing Delays: Escrow or title problems occur.

Tax Reporting: Incorrect TINs trigger withholding.

eSignature Pricing and Feature Comparison for Disclosure Forms

Compare per-user pricing, trial availability, and compliance features when choosing an eSignature provider for agency disclosures and secure transaction records.

	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	Yes, 7-day trial	Varies	Varies	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
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions About the Real Estate Agency Disclosure Form

Answers to common questions about completing, delivering, and validating the Real Estate Agency Disclosure Form for U.S. real estate transactions.

Need help? Contact support

Is this form legally binding?
Yes. An electronically signed disclosure is generally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and retention requirements are met. Exceptions such as wills and court filings may still require wet signatures.
Do I need a notary or witnesses?
Usually no; most states do not require notarization for agency disclosure forms. Specific jurisdictions or transaction types may require witnesses or notarization, so verify state rules. For documents that do require notarization, use remote online notarization or in-person notarization consistent with state law.
When must the disclosure be provided?
Provide the disclosure at first substantive contact or before entering into a brokerage agreement as required by some states. Deliver a signed copy to each party and retain one in the brokerage file to satisfy regulatory audits and dispute inquiries.
Can disclosures be signed electronically?
Yes. Electronic signatures on disclosures are permitted under ESIGN (15 U.S.C. ch. 96) and UETA when the signatory demonstrates intent, provides consent to electronic records, attribution is clear, and the platform preserves an accurate record of the signed form.
What if names or license numbers are wrong?
Correct any mismatches immediately. Inaccurate names or license numbers can affect tax reporting, title work, and regulatory compliance. Amendments should be initialed and dated by parties; consult counsel for material errors before closing.
How long should I keep the signed disclosure?
Keep disclosures in the brokerage file for the transaction term plus at least three years to meet federal IRS recordkeeping minimums (IRC §6501(a)); retain longer if state law or industry rules require extended periods.

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