Page 1 of 2 Effective 02/10/19
AGENCY DISCLOSURE STATEMENT
The real estate agent who is providing you with this form is required to do so by Ohio law. You will not be bound to pay the
agent or the agent’s brokerage by merely signing this form. Instead, the purpose of this form is to confirm that you have been
advised of the role of the agent(s) in the transaction proposed below. (For purposes of this form, the term “seller” includes a landlord
and the term “buyer” includes a tenant.)
Property Address: ____________________________________________________________________________________________
Buyer(s): __________________________________________________________________________________________________
Seller(s): __________________________________________________________________________________________________
I. TRANSACTION INVOLVING TWO AGENTS IN TWO DIFFERENT BROKERAGES
The buyer will be represented by ______________________________________________, and ______________________________.
The seller will be represented by ______________________________________________, and ______________________________.
II. TRANSACTION INVOLVING TWO AGENTS IN THE SAME BROKERAGE
If two agents in the real estate brokerage ___________________________________________________________________________
represent both the buyer and the seller, check the following relationship that will apply:
Agent(s)_____________________________________________________________ work(s) for the buyer and
Agent(s)_____________________________________________________________ work(s) for the seller. Unless personally
involved in the transaction, the principal broker and managers will be “dual agents,” which is further explained on the back of this
form. As dual agents they will maintain a neutral position in the transaction and they will protect all parties’ confidential
information.
Every agent in the brokerage represents every “client” of the brokerage. Therefore, agents ______________________________
and _____________________________ will be working for both the buyer and seller as “dual agents.” Dual agency is explained
on the back of this form. As dual agents they will maintain a neutral position in the transaction and they will protect all parties’
confidential information. Unless indicated below, neither the agent(s) nor the brokerage acting as a dual agent in this transaction
has a personal, family or business relationship with either the buyer or seller. If such a relationship does exist, explain:
_______________________________________________________________________________________________________.
III. TRANSACTION INVOLVING ONLY ONE REAL ESTATE AGENT
Agent(s) ______________________________________ and real estate brokerage _____________________________________ will
be “dual agents” representing both parties in this transaction in a neutral capacity. Dual agency is further explained on the back of
this form. As dual agents they will maintain a neutral position in the transaction and they will protect all parties’ confidential
information. Unless indicated below, neither the agent(s) nor the brokerage acting as a dual agent in this transaction has a
personal, family or business relationship with either the buyer or seller. If such a relationship does exist, explain: ____________
_______________________________________________________________________________________________________.
represent only the (check one) seller or buyer in this transaction as a client. The other party is not represented and agrees to
represent his/her own best interest. Any information provided the agent may be disclosed to the agent’s client.
CONSENT
I (we) consent to the above relationships as we enter into this real estate transaction. If there is a dual agency in this transaction, I
(we) acknowledge reading the information regarding dual agency explained on the back of this form.
_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________
AGENT(S)
BROKERAGE
AGENT(S)
BROKERAGE
BUYER/TENANT DATE
BUYER/TENANT DATE
SELLER/LANDLORD DATE
SELLER/LANDLORD DATE
Page 2 of 2 Effective 02/10/19
DUAL AGENCY
Ohio law permits a real estate agent and brokerage to represent both the seller and buyer in a real estate transaction as long as this is
disclosed to both parties and they both agree. This is known as dual agency. As a dual agent, a real estate agent and brokerage
represent two clients whose interests are, or at times could be, different or adverse. For this reason, the dual agent(s) may not be able
to advocate on behalf of the client to the same extent the agent may have if the agent represented only one client.
As a dual agent, the agent(s) and brokerage shall:
Treat both clients honestly;
Disclose latent (not readily observable) material defects to the purchaser, if known by the agent(s) or brokerage;
Provide information regarding lenders, inspectors and other professionals, if requested;
Provide market information available from a property listing service or public records, if requested;
Prepare and present all offers and counteroffers at the direction of the parties;
Assist both parties in completing the steps necessary to fulfill the terms of any contract, if requested.
As a dual agent, the agent(s) and brokerage shall not:
Disclose information that is confidential, or that would have an adverse effect on one party’s position in the transaction,
unless such disclosure is authorized by the client or required by law;
Advocate or negotiate on behalf of either the buyer or seller;
Suggest or recommend specific terms, including price, or disclose the terms or price a buyer is willing to offer or that a seller
is willing to accept;
Engage in conduct that is contrary to the instructions of either party and may not act in a biased manner on behalf of one
party.
Compensation: Unless agreed otherwise, the brokerage will be compensated per the agency agreement.
Management Level Licensees: Generally, the principal broker and managers in a brokerage also represent the interests of any buyer
or seller represented by an agent affiliated with that brokerage. Therefore, if both buyer and seller are represented by agents in the
same brokerage, the principal broker and manager are dual agents. There are two exceptions to this. The first is where the principal
broker or manager is personally representing one of the parties. The second is where the principal broker or manager is selling or
buying his own real estate. These exceptions only apply if there is another principal broker or manager to supervise the other agent
involved in the transaction.
Responsibilities of the Parties: The duties of the agent and brokerage in a real estate transaction do not relieve the buyer and seller
from the responsibility to protect their own interests. The buyer and seller are advised to carefully read all agreements to assure that
they adequately express their understanding of the transaction. The agent and brokerage are qualified to advise on real estate matters.
IF LEGAL OR TAX ADVICE IS DESIRED, YOU SHOULD CONSULT THE APPROPRIATE PROFESSIONAL.
Consent: By signing on the reverse side, you acknowledge that you have read and understand this form and are giving your
voluntary, informed consent to the agency relationship disclosed. If you do not agree to the agent(s) and/or brokerage acting as a dual
agent, you are not required to consent to this agreement and you may either request a separate agent in the brokerage to be appointed
to represent your interests or you may terminate your agency relationship and obtain representation from another brokerage.
Any questions regarding the role or responsibilities of the brokerage or its agents should be directed to: attorney or to:
Ohio Department of Commerce
Division of Real Estate & Professional Licensing
77 S. High Street, 20
th
Floor
Columbus, OH 43215-6133
(614) 466-4100